Performance of a Novel Low-Cost, Instrument-Free Plasma Separation Device for HIV Viral Load Quantification and Determination of Treatment Failure in People Living with HIV in Malaysia: a Diagnostic Accuracy Study

HIV viral load (VL) testing is the recommended method for monitoring the response of people living with HIV and receiving antiretroviral therapy (ART). The availability of standard plasma VL testing in low- and middle-income countries (LMICs), and access to this testing, are limited by the need to use fresh plasma. Good specimen collection methods for HIV VL testing that are applicable to resource-constrained settings are needed. We assessed the diagnostic performance of the filtered dried plasma spot (FDPS), created using the newly developed, instrument-free VLPlasma device, in identifying treatment failure at a VL threshold of 1,000 copies/ml in fresh plasma. Performance was compared with that of the conventional dried blood spot (DBS). Venous blood samples from 201 people living with HIV and attending an infectious disease clinic in Malaysia were collected, and HIV VL was quantified using fresh plasma (the reference standard), FDPS, and DBS specimens. VL testing was done using the Roche Cobas AmpliPrep/Cobas TaqMan v2.0 assay. At a threshold of 1,000 copies/ml, the diagnostic performance of the FDPS was superior (sensitivity, 100% [95% confidence interval {CI}, 89.1 to 100%]; specificity, 100% [95% CI, 97.8 to 100%]) to that of the DBS (sensitivity, 100% [95% CI, 89.4 to 100%]; specificity, 36.8% [95% CI, 29.4 to 44.7%]) (P 0.001). A stronger correlation was observed between the FDPS VL and the plasma VL (r 0.94; P 0.001) than between the DBS VL and the plasma VL (r 0.85; P 0.001). The mean difference in VL measures between the FDPS and plasma (plasma VL minus FDPS VL) was 0.127 log10 copies/ml (standard deviation [SD], 0.32), in contrast to – 0.95 log10 copies/ml (SD, 0.84) between the DBS and plasma. HIV VL measurement using the FDPS outperformed that with the DBS in identifying treatment failure at a threshold of 1,000 copies/ml and compared well with the quantification of VL in plasma. The FDPS can be an attractive alternative to fresh plasma for improving access to HIV VL monitoring among people living with HIV on ART in LMICs

European pharmaceutical journals: Relationship between demand and indexation - the example of the main French document supplier

The purpose of the study was to analyse the way in which papers published by European pharmaceutical journals are made available by the main French document supplier, “ Institut National de l'Information Scientifique et Technique ” linked to the “ Centre National de la Recherche Scientifique ” (INIST-CNRS). After having given a definition and built up a sample of 289 journals, orders for them during 1996-1999 were analysed. Then, the possible relationships between orders to INIST-CNRS and the impact of journals on the scientific community (from Institute for Scientific Information (ISI) data) were examined. Finally, a study was made of relationships between document orders to INIST-CNRS and the indexation of European pharmaceutical journals in bibliographic databases.Notre travail avait pour objectif d'analyser le processus de fourniture d'articles publiés dans les périodiques pharmaceutiques européens, par le principal fournisseur de documents qu'est l'Institut National de l'Information Scientifique et Technique lié au Centre National de la Recherche Scientifique (INIST-CNRS). Après avoir donné une définition et constitué un échantillon de 289 périodiques, nous avons analysé les demandes les concernant sur la période 1996-1999. Nous avons envisagé ensuite les relations éventuelles entre ces demandes auprès de l'INIST-CNRS et l'impact des périodiques dans la communauté scientifique (à partir de données issues de l'Institute for Scientific Information (ISI) aux USA). Enfin, nous avons étudié les relations existant entre les commandes de documents à l'INIST-CNRS et le signalement des périodiques pharmaceutiques européens dans les bases de données bibliographiques

Assessing the robustness of future extreme precipitation intensification in the CMIP5 ensemble

© 2018 American Meteorological Society. A warming climate is expected to intensify extreme precipitation, and climate models project a general intensification of annual extreme precipitation in most regions of the globe throughout the twenty-first century. We investigate the robustness of this future intensification over land across different models, regions, and seasons and evaluate the role of model interdependencies in the CMIP5 ensemble. Strong similarities in extreme precipitation changes are found between models that share atmospheric physics, turning an ensemble of 27 models into around 14 projections. We find that future annual extreme precipitation intensity increases in the majority of models and in the majority of land grid cells, from the driest to the wettest regions, as defined by each model's precipitation climatology. The intermodel spread is generally larger over wet than over dry regions, smaller in the dry season compared to the wet season and at the annual scale, and largely reduced in extratropical compared to tropical regions and at the global scale. For each model, the future increase in annual and seasonal maximum daily precipitation amounts exceeds the range of simulated internal variability in the majority of land grid cells. At both annual and seasonal scales, however, there are a few regions where the change is still within the background climate noise, but their size and location differ between models. In extratropical regions, the signal-to-noise ratio of projected changes in extreme precipitation is particularly robust across models because of a similar change and background climate noise, whereas projected changes are less robust in the tropics

On the Robustness of Annual Daily Precipitation Maxima Estimates Over Monsoon Asia

Understanding precipitation extremes over Monsoon Asia is vital for water resource management and hazard mitigation, but there are many gaps and uncertainties in observations in this region. To better understand observational uncertainties, this study uses a high-resolution validation dataset to assess the consistency of the representation of annual daily precipitation maxima (Rx1day) over land in 13 observational datasets from the Frequent Rainfall Observations on Grids (FROGS) database. The FROGS datasets are grouped into three categories: in situ-based and satellite-based with and without corrections to rain gauges. We also look at three sub-regions: Japan, India, and the Maritime Continent based on their different station density, orography, and coastal complexity. We find broad similarities in spatial and temporal distributions among in situ-based products over Monsoon Asia. Satellite products with correction to rain gauges show better general agreement and less inter-product spread than their uncorrected counterparts. However, this comparison also reveals strong sub-regional differences that can be explained by the quantity and quality of rain gauges. High consistency in spatial and temporal patterns are observed over Japan, which has a dense station network, while large inter-product spread is found over the Maritime Continent and India, which have sparser station density. We also highlight that while corrected satellite products show improvement compared to uncorrected products in regions of high station density (e.g., Japan) they have mixed success over other regions (e.g., India and the Maritime Continent). In addition, the length of record available at each station can also affect the satellite correction over these poorly sampled regions. Results of the additional comparison between all considered datasets and the sub-regional high resolution dataset remain the same, indicating that the overall quality of the station network has implications for the reliability of the in situ-based products derived and also the satellite products that use a correction to in situ data. Given these uncertainties in observations, there is no single best dataset for assessment of Rx1day in Monsoon Asia. In all cases we recommend users understand how each dataset is produced in order to select the most appropriate product to estimate precipitation extremes to fit their purpose

Multisensitive community-acquired methicillin-resistant Staphylococcus aureus infections in Malaysia

The 1st 9 clinical isolates of multisensitive community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) from Malaysia carry SCCmec type IN and predominantly cause skin and soft-tissue infections. Seven were classified as nosocomially acquired. There was considerable clonal diversity, with both pandemic and novel multilocus sequence types detected. CA-MRSA rates appear to be increasing in our hospital, warranting close surveillance. (C) 2008 Elsevier Inc. All rights reserved