MDR-TB patient’s travel trajectory from Hpa An, Myanmar to seek TB treatment in Tak province.

<p>Lines indicate travel pattern. Image similar but not identical to original created using the USGS National Map Viewer and therefore used for illustrative purposes only.</p

Composition of TB Patient Focus Groups.

<p>Composition of TB Patient Focus Groups.</p

Relationship between colonisation density and agreement between WHO culture and latex sweep result.

<p>Relationship between colonisation density and agreement between WHO culture and latex sweep result.</p

Study flow diagram.

<p>* Described in detail in reference <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0067933#pone.0067933-Turner3" target="_blank">[8]</a>.</p

Comparison of NPS culture and serotyping results by processing method.

<p>1,107 nasopharyngeal swabs evaluated by both methods.</p

Infant carriage pneumococcal serotype distribution, by latex sweep serotyping.

<p>Results of culture of 8,736 swabs from 364 infants. The bars indicate the number of isolates of each serotype and the dashed lines indicate the cumulative frequency (cumulative frequency of 67% is indicated by the vertical arrows). Dark grey bars highlight PCV13 serotypes.</p

Duration of first pneumococcal carriage episode, stratified by NPS culture/serotyping method.

<p>100 infants were included in each group.</p

Individual pneumococcal serotype acquisition rates, by NPS culture/serotyping method.

<p>100 infants were included in each group; each serotype considered independently.</p>a<p>Acquisition rate per day.</p>b<p>Non-typeable pneumococcal colonisation excluded.</p

Validation of the quantitative point-of-care CareStart biosensor for assessment of G6PD activity in venous blood

<div><p>Introduction</p><p>Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymopathy in the human population affecting an estimated 8% of the world population, especially those living in areas of past and present malaria endemicity. Decreased G6PD enzymatic activity is associated with drug-induced hemolysis and increased risk of severe neonatal hyperbilirubinemia leading to brain damage. The G6PD gene is on the X chromosome therefore mutations cause enzymatic deficiency in hemizygote males and homozygote females while the majority of heterozygous females have an intermediate activity (between 30–80% of normal) with a large distribution into the range of deficiency and normality. Current G6PD qualitative tests are unable to diagnose G6PD intermediate activities which could hinder wide use of 8-aminoquinolines for <i>Plasmodium vivax</i> elimination. The aim of the study was to assess the diagnostic performances of the new Carestart G6PD quantitative biosensor.</p><p>Methods</p><p>A total of 150 samples of venous blood with G6PD deficient, intermediate and normal phenotypes were collected among healthy volunteers living along the north-western Thailand-Myanmar border. Samples were analyzed by complete blood count, by gold standard spectrophotometric assay using Trinity kits and by the latest model of Carestart G6PD biosensor which analyzes both G6PD and hemoglobin.</p><p>Results</p><p>Bland-Altman comparison of the CareStart normalized G6PD values to that of the gold standard assay showed a strong bias in values resulting in poor area under-the-curve values for both 30% and 80% thresholds. Performing a receiver operator curve identified threshold values for the CareStart product equivalent to the 30% and 80% gold standard values with good sensitivity and specificity values, 100% and 92% (for 30% G6PD activity) and 92% and 94% (for 80% activity) respectively.</p><p>Conclusion</p><p>The Carestart G6PD biosensor represents a significant improvement for quantitative diagnosis of G6PD deficiency over previous versions. Further improvements and validation studies are required to assess its utility for informing radical cure decisions in malaria endemic settings.</p></div

Threshold normalized G6PD activity values on the CareStart biosensor optimized to maximize sensitivity and specificity using Youden’s Index.

<p>Threshold normalized G6PD activity values on the CareStart biosensor optimized to maximize sensitivity and specificity using Youden’s Index.</p