19 research outputs found
Repurposing rapid diagnostic tests to detect falsified vaccines in supply chains
Substandard (including degraded) and falsified (SF) vaccines are a relatively neglected issue with serious global implications for public health. This has been highlighted during the rapid and widespread rollout of COVID-19 vaccines. There has been increasing interest in devices to screen for SF non-vaccine medicines including tablets and capsules to empower inspectors and standardise surveillance. However, there has been very limited published research focussed on repurposing or developing new devices for screening for SF vaccines. To our knowledge, rapid diagnostic tests (RDTs) have not been used for this purpose but have important potential for detecting falsified vaccines. We performed a proof-in-principle study to investigate their diagnostic accuracy using a diverse range of RDT-vaccine/falsified vaccine surrogate pairs. In an initial assessment, we demonstrated the utility of four RDTs in detecting seven vaccines. Subsequently, the four RDTs were evaluated by three blinded assessors with seven vaccines and four falsified vaccines surrogates. The results provide preliminary data that RDTs could be used by multiple international organisations, national medicines regulators and vaccine manufacturers/distributors to screen for falsified vaccines in supply chains, aligned with the WHO global âPrevent, Detect and Respondâ strategy
Validation of a Novel Multivariate Method of Defining HIV-Associated Cognitive Impairment
Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown. We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patientreported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts.Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER, and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria.Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P<.05). There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean cortical thickness in both hemispheres (P<.05), as well as smaller brain volumes (P<.01). The associations with measures of white matter microstructure and brain-predicted age generally were weaker.Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approach
Level of agreement between frequently used cardiovascular risk calculators in people living with HIV
Objectives
The aim of the study was to describe agreement between the QRISK2, Framingham and Data Collection on Adverse Events of AntiâHIV Drugs (D:A:D) cardiovascular disease (CVD) risk calculators in a large UK study of people living with HIV (PLWH).
Methods
PLWH enrolled in the Pharmacokinetic and Clinical Observations in People over Fifty (POPPY) study without a prior CVD event were included in this study. QRISK2, Framingham CVD and the full and reduced D:A:D CVD scores were calculated; participants were stratified into âlowâ ( 20%) categories for each. Agreement between scores was assessed using weighted kappas and BlandâAltman plots.
Results
The 730 included participants were predominantly male (636; 87.1%) and of white ethnicity (645; 88.5%), with a median age of 53 [interquartile range (IQR) 49â59] years. The median calculated 10âyear CVD risk was 11.9% (IQR 6.8â18.4%), 8.9% (IQR 4.6â15.0%), 8.5% (IQR 4.8â14.6%) and 6.9% (IQR 4.1â11.1%) when using the Framingham, QRISK2, and full and reduced D:A:D scores, respectively. Agreement between the different scores was generally moderate, with the highest level of agreement being between the Framingham and QRISK2 scores (weighted kappa = 0.65) but with most other kappa coefficients in the 0.50â0.60 range.
Conclusions
Estimates of predicted 10âyear CVD risk obtained with commonly used CVD risk prediction tools demonstrate, in general, only moderate agreement among PLWH in the UK. While further validation with clinical endpoints is required, our findings suggest that care should be taken when interpreting any score alone
Validation of a novel multivariate method of defining HIV-associated cognitive impairment
Background. The optimum method of defining cognitive impairment in virally suppressed people living with HIV is unknown.
We evaluated the relationships between cognitive impairment, including using a novel multivariate method (NMM), patientâ
reported outcome measures (PROMs), and neuroimaging markers of brain structure across 3 cohorts.
Methods. Differences in the prevalence of cognitive impairment, PROMs, and neuroimaging data from the COBRA, CHARTER,
and POPPY cohorts (total n = 908) were determined between HIV-positive participants with and without cognitive impairment defined using the HIV-associated neurocognitive disorders (HAND), global deficit score (GDS), and NMM criteria.
Results. The prevalence of cognitive impairment varied by up to 27% between methods used to define impairment (eg, 48% for HAND
vs 21% for NMM in the CHARTER study). Associations between objective cognitive impairment and subjective cognitive complaints generally were weak. Physical and mental health summary scores (SF-36) were lowest for NMM-defined impairment (P < .05).
There were no differences in brain volumes or cortical thickness between participants with and without cognitive impairment defined using the HAND and GDS measures. In contrast, those identified with cognitive impairment by the NMM had reduced mean
cortical thickness in both hemispheres (P < .05), as well as smaller brain volumes (P < .01). The associations with measures of white
matter microstructure and brain-predicted age generally were weaker.
Conclusion. Different methods of defining cognitive impairment identify different people with varying symptomatology and
measures of brain injury. Overall, NMM-defined impairment was associated with most neuroimaging abnormalities and poorer selfreported health status. This may be due to the statistical advantage of using a multivariate approac
Gandhianism in London: Bringing the past to bear on the present in discussion of the social work and spirituality of Muriel and Doris Lester
This article considers Gandhian social work in relation to spirituality and as carried out by Muriel and Doris Lester, two British social workers from the first half of the 20th century. Following a brief literature review the article focuses on how examples from the lives of these women illustrate Gandhian ideas such as SatyÄgraha and Swadesh. It emphasizes the spiritual elements in these ideas and their ongoing relevance. A biographical approach is used and contemporary resonances are drawn out. The article emphasizes the importance of narrative for developing contemporary understandings of social work and spirituality