Variation in Specificity of HIV Rapid Diagnostic Tests over Place and Time: An Analysis of Discordancy Data Using a Bayesian Approach

BACKGROUND Recent trends to earlier access to anti-retroviral treatment underline the importance of accurate HIV diagnosis. The WHO HIV testing strategy recommends the use of two or three rapid diagnostic tests (RDTs) combined in an algorithm and assume a population is serologically stable over time. Yet RDTs are prone to cross reactivity which can lead to false positive or discordant results. This paper uses discordancy data from Médecins Sans Frontières (MSF) programmes to test the hypothesis that the specificity of RDTs change over place and time. METHODS Data was drawn from all MSF test centres in 2007-8 using a parallel testing algorithm. A Bayesian approach was used to derive estimates of disease prevalence, and of test sensitivity and specificity using the software WinBUGS. A comparison of models with different levels of complexity was performed to assess the evidence for changes in test characteristics by location and over time. RESULTS 106, 035 individuals were included from 51 centres in 10 countries using 7 different RDTs. Discordancy patterns were found to vary by location and time. Model fit statistics confirmed this, with improved fit to the data when test specificity and sensitivity were allowed to vary by centre and over time. Two examples show evidence of variation in specificity between different testing locations within a single country. Finally, within a single test centre, variation in specificity was seen over time with one test becoming more specific and the other less specific. CONCLUSION This analysis demonstrates the variable specificity of multiple HIV RDTs over geographic location and time. This variability suggests that cross reactivity is occurring and indicates a higher than previously appreciated risk of false positive HIV results using the current WHO testing guidelines. Given the significant consequences of false HIV diagnosis, we suggest that current testing and evaluation strategies be reviewed.The authors have no funding or support to report

Enhanced esports: Community perspectives on performance enhancers in competitive gaming

This work explores perceptions of performance enhancer usage in esports. Specifically, we explored the perception of: food and food supplements; non-medical use of prescription drugs; drugs with some social acceptance (e.g. alcohol, nicotine, cannabis); drugs with lower social acceptance (e.g., psychedelics, opioids); and non-invasive brain stimulation (e.g. transcranial direct current stimulation). A mixed-methods approach was used to triangulate findings around three data sets, including both prompted and unprompted online forum comments, as well as survey data. The studies evidence that players are willing to use or are already using enhancers to increase their in-game performance, and that players are generally concerned about the use of enhancers in professional esports contexts. Furthermore, the community perceives that a substantial number of e-athletes use enhancers. The core contribution of this work is a comprehensive investigation into perspectives of esports performance enhancement, which highlights the urgent need for further research, as well as regulation by esports leagues

Field testing of World Health Organization (WHO) 2003 recommendations for initiating anti-retroviral therapy (ART) where CD4 is not available revealed low sensitivity among stage I and II patients; a combination of Automated Total Lymphocyte Count (TLC) and Haemoglobin (Hgb) can ration the referral for CD4 testing.

2006 AIDS Conference, Toront

Fighting fair:community perspectives on the fairness of performance enhancement in esports

Aims: This study aims to explore community perspectives on enhancer usage in competitive gaming and esports, focusing on the perception of fairness and concerns about various potential performance enhancers. Methods: We conducted both qualitative and quantitative surveys to understand the competitive gaming community's opinions on different types of performance enhancers and their potential impact on esports. A thematic analysis was performed to identify key themes in how players rationalize their opinions. Conclusions: The gaming community differentiates between potential performance enhancers based on how problematic they are for the esports scene, with the most concern surrounding hard drugs, pharmaceuticals, and brain stimulation interventions. Participants who are more invested in competitive gaming tend to be more sceptical of enhancers and express greater concerns. Four themes were identified in the thematic analysis: (1) risk, (2) morality, (3) enhancer effects, and (4) regulation. To increase acceptance and perceived legitimacy in decision-making, it is recommended that regulators engage a variety of stakeholders in transparent decision-making processes when forming tournament rules and regulations. This will help address the fragmented regulatory landscape and prevent potential differences in the perception of tournament winners based on the governing body supervising the competition.</p

Microscopy Quality Control in Médecins Sans Frontières Programs in Resource-Limited Settings

Derryck Klarkowski and Daniel Orozco describe the Médecins Sans Frontières program for monitoring the quality of microscopy for malaria, pulmonary tuberculosis, and leishmaniasis

Player experience and deceptive expectations of difficulty adaptation in digital games

Increasingly, digital games are including adaptive features that adjust the level of difficulty to match the skills of individual players. The intention is to improve and prolong the player experience by allowing the player to have the feeling of challenge without it being overwhelming and leading to repeated failure and frustration. Previous work has shown that player experience is indeed improved by such adaptations but also that the player experience can be improved by simply claiming such an adaptation is present even when it is not. It is therefore possible that claims about adaptations and the actual adaptations could interact and not lead to the intended outcomes for the players or worse disappoint players. This paper reports on two studies that were conducted to experimentally investigate the interaction between game adaptations and player information about adaptations on the player experience, specifically their sense of immersion in the game. For this, two games were developed using two different kinds of adaptations to adjust difficulty based on players’ performance in the game. Participants were provided with information about game adaptations independently of whether the adaptations were present. The results suggest that players felt more immersed in the game when told that the game adapts to them, regardless of whether the adaptation was present in the game or not. This effect was observed in both games despite their different adaptations and it remained prominent even during longer gaming sessions. These findings demonstrate that players’ knowledge of adaptations influences their experience independently of adaptations. In this particular context, the knowledge reinforced the experience of the adaptations. This suggests that, at least in some circumstances, developers do not need to be concerned about negative effects of telling players about in-game adaptations

Suspecting Sarcasm: How League of Legends Players Dismiss Positive Communication in Toxic Environments

Toxicity in multiplayer gaming is an ongoing problem that threatens the well-being of players, gaming communities, and game developers. Meanwhile, interventions that promote positive interactions and proactively create positive gaming spaces are still in their infancy; little is known about how players respond to positivity. In our study, 959 League of Legends players were presented with either 10 positive chat logs or 10 negative chat logs, and asked to reflect on the content and how representative such communication is of their own gaming experiences. We thematically coded participants' free-form answers (identifying the themes normalize, acknowledge, downplay, cope, blame, and make personal), and compared the positive and negative conditions in terms of theme prevalence. Our findings show that participants were more likely to normalize and acknowledge toxic negativity than positivity. Furthermore, the dominant response to positivity consisted of downplaying messages as not representative and rare, and even expressing suspicion that messages must have been fabricated or intended as sarcasm. Participants overwhelmingly cope by muting chat, protecting them from toxic interactions, but leaving them unexposed to positive communication and other beneficial social interactions within play

Fighting fair: community perspectives on the fairness of performance enhancement in esports

Aims: This study aims to explore community perspectives on enhancer usage in competitive gaming and esports, focusing on the perception of fairness and concerns about various potential performance enhancers. Methods: We conducted both qualitative and quantitative surveys to understand the competitive gaming community's opinions on different types of performance enhancers and their potential impact on esports. A thematic analysis was performed to identify key themes in how players rationalize their opinions. Conclusions: The gaming community differentiates between potential performance enhancers based on how problematic they are for the esports scene, with the most concern surrounding hard drugs, pharmaceuticals, and brain stimulation interventions. Participants who are more invested in competitive gaming tend to be more sceptical of enhancers and express greater concerns. Four themes were identified in the thematic analysis: (1) risk, (2) morality, (3) enhancer effects, and (4) regulation. To increase acceptance and perceived legitimacy in decision-making, it is recommended that regulators engage a variety of stakeholders in transparent decision-making processes when forming tournament rules and regulations. This will help address the fragmented regulatory landscape and prevent potential differences in the perception of tournament winners based on the governing body supervising the competition

Dilution testing using rapid diagnostic tests in a HIV diagnostic algorithm: a novel alternative for confirmation testing in resource limited settings.

BACKGROUND: Current WHO testing guidelines for resource limited settings diagnose HIV on the basis of screening tests without a confirmation test due to cost constraints. This leads to a potential risk of false positive HIV diagnosis. In this paper, we evaluate the dilution test, a novel method for confirmation testing, which is simple, rapid, and low cost. The principle of the dilution test is to alter the sensitivity of a rapid diagnostic test (RDT) by dilution of the sample, in order to screen out the cross reacting antibodies responsible for falsely positive RDT results. METHODS: Participants were recruited from two testing centres in Ethiopia where a tiebreaker algorithm using 3 different RDTs in series is used to diagnose HIV. All samples positive on the initial screening RDT and every 10th negative sample underwent testing with the gold standard and dilution test. Dilution testing was performed using Determine™ rapid diagnostic test at 6 different dilutions. Results were compared to the gold standard of Western Blot; where Western Blot was indeterminate, PCR testing determined the final result. RESULTS: 2895 samples were recruited to the study. 247 were positive for a prevalence of 8.5 % (247/2895). A total of 495 samples underwent dilution testing. The RDT diagnostic algorithm misclassified 18 samples as positive. Dilution at the level of 1/160 was able to correctly identify all these 18 false positives, but at a cost of a single false negative result (sensitivity 99.6 %, 95 % CI 97.8-100; specificity 100 %, 95 % CI: 98.5-100). Concordance between the gold standard and the 1/160 dilution strength was 99.8 %. CONCLUSION: This study provides proof of concept for a new, low cost method of confirming HIV diagnosis in resource-limited settings. It has potential for use as a supplementary test in a confirmatory algorithm, whereby double positive RDT results undergo dilution testing, with positive results confirming HIV infection. Negative results require nucleic acid testing to rule out false negative results due to seroconversion or misclassification by the lower sensitivity dilution test. Further research is needed to determine if these results can be replicated in other settings. TRIAL REGISTRATION: ClinicalTrials.gov, NCT01716299

Don’t You Know That You’re Toxic: Normalization of Toxicity in Online Gaming

Peer ReviewedVideo game toxicity, endemic to online play, represents a pervasive and complex problem. Antisocial behaviours in online play directly harm player wellbeing, enjoyment, and retention—but research has also revealed that some players normalize toxicity as an inextricable and acceptable element of the competitive video game experience. In this work, we explore perceptions of toxicity and how they are predicted by player traits, demonstrating that participants reporting a higher tendency towards Conduct Reconstrual, Distorting Consequences, Dehumanization, and Toxic Online Disinhibition perceive online game interactions as less toxic. Through a thematic analysis on willingness to report, we also demonstrate that players abstain from reporting toxic content because they view it as acceptable, typical of games, as banter, or as not their concern. We propose that these traits and themes represent contributing factors to the cyclical normalization of toxicity. These findings further highlight the multifaceted nature of toxicity in online video games