Assessment of two malaria rapid diagnostic tests in children under five years of age, with follow-up of false-positive pLDH test results, in a hyperendemic falciparum malaria area, Sierra Leone

ABSTRACT: BACKGROUND: Most malaria rapid diagnostic tests (RDTs) use HRP2 detection, including Paracheck-Pf(R), but their utility is limited by persistent false positivity after treatment. PLDH-based tests become negative more quickly, but sensitivity has been reported below the recommended standard of 90%. A new pLDH test, CareStartTM three-line P.f/PAN-pLDH, claims better sensitivity with continued rapid conversion to negative. The study aims were to 1) compare sensitivity and specificity of CareStartTM to Paracheck-Pf(R) to diagnose falciparum malaria in children under five years of age, 2) assess how quickly false-positive CareStartTM tests become negative and 3) evaluate ease of use and inter-reader agreement of both tests. METHODS: Participants were included if they were aged between two and 59 months, presenting to a Medecins Sans Frontieres community health centre in eastern Sierra Leone with suspected malaria defined as fever (axillary temperature > 37.5degreesC) and/or history of fever in the previous 72 hours and no signs of severe disease. The same capillary blood was used for the RDTs and the blood slide, the latter used as the gold standard reference. All positive participants were treated with supervised artesunate and amodiaquine treatment for three days. Participants with a persistent false-positive CareStartTM, but a negative blood slide on Day 2, were followed with repeated CareStartTM and blood slide tests every seven days until CareStartTM became negative or a maximum of 28 days. RESULTS: Sensitivity of CareStartTM was 99.4% (CI 96.8-100.0, 168/169) and of Paracheck-Pf(R), 98.8% (95% CI 95.8-99.8, 167/169). Specificity of CareStartTM was 96.0% (CI 91.9-98.4, 167/174) and of Paracheck-Pf(R), 74.7% (CI 67.6-81.0, 130/174) (p<0.001). Neither test showed any change in sensitivity with decreasing parasitaemia. Of the 155 eligible follow-up CareStartTM participants, 63.9% (99/155) had a false-positive test on day 2, 21.3% (33/155) on day 7, 5.8% (9/155) on day 14, 1.9% (3/155) on day 21 and 0.6% (1/155) on day 28. The median time for test negativity was seven days. CareStartTM was as easy to use and interpret as Paracheck-Pf(R) with excellent inter-reader agreement. CONCLUSIONS: Both RDTs were highly sensitive, met WHO standards for the detection of falciparum malaria monoinfections where parasitaemia was >100 parasites/mul and were easy to use. CareStartTM persistent false positivity decreased quickly after successful anti-malarial treatment, making it a good choice for a RDT for a hyperendemic falciparum malaria area

Hydroponic technologies

This open access book, written by world experts in aquaponics and related technologies, provides the authoritative and comprehensive overview of the key aquaculture and hydroponic and other integrated systems, socio-economic and environmental aspects. Aquaponic systems, which combine aquaculture and vegetable food production offer alternative technology solutions for a world that is increasingly under stress through population growth, urbanisation, water shortages, land and soil degradation, environmental pollution, world hunger and climate change.Hydroponics is a method to grow crops without soil, and as such, these systems are added to aquaculture components to create aquaponics systems. Thus, together with the recirculating aquaculture system (RAS), hydroponic production forms a key part of the aqua-agricultural system of aquaponics. Many different existing hydroponic technologies can be applied when designing aquaponics systems. This depends on the environmental and financial circumstances, the type of crop that is cultivated and the available space. This chapter provides an overview of different hydroponic types, including substrates, nutrients and nutrient solutions, and disinfection methods of the recirculating nutrient solutions

HIV-associated neurocognitive disorders before and during the era of combination antiretroviral therapy: differences in rates, nature, and predictors

Combination antiretroviral therapy (CART) has greatly reduced medical morbidity and mortality with HIV infection, but high rates of HIV-associated neurocognitive disorders (HAND) continue to be reported. Because large HIV-infected (HIV+) and uninfected (HIV−) groups have not been studied with similar methods in the pre-CART and CART eras, it is unclear whether CART has changed the prevalence, nature, and clinical correlates of HAND. We used comparable methods of subject screening and assessments to classify neurocognitive impairment (NCI) in large groups of HIV + and HIV − participants from the pre-CART era (1988–1995; N = 857) and CART era (2000–2007; N = 937). Impairment rate increased with successive disease stages (CDC stages A, B, and C) in both eras: 25%, 42%, and 52% in pre-CART era and 36%, 40%, and 45% in CART era. In the medically asymptomatic stage (CDC-A), NCI was significantly more common in the CART era. Low nadir CD4 predicted NCI in both eras, whereas degree of current immunosuppression, estimated duration of infection, and viral suppression in CSF (on treatment) were related to impairment only pre-CART. Pattern of NCI also differed: pre-CART had more impairment in motor skills, cognitive speed, and verbal fluency, whereas CART era involved more memory (learning) and executive function impairment. High rates of mild NCI persist at all stages of HIV infection, despite improved viral suppression and immune reconstitution with CART. The consistent association of NCI with nadir CD4 across eras suggests that earlier treatment to prevent severe immunosuppression may also help prevent HAND. Clinical trials targeting HAND prevention should specifically examine timing of ART initiation

Backbending, seniority, and Pauli blocking of pairing correlations at high rotational frequencies in rapidly rotating nuclei

Garrett et al. systematically investigated band-crossing frequencies resulting from the rotational alignment of the first pair of i13/2 neutrons (AB) in rare-earth nuclei. In that study, evidence was found for an odd-even neutron number dependence attributed to changes in the strength of neutron pairing correlations. The present paper carries out a similar investigation at higher rotational frequencies for the second pair of aligning i13/2 neutrons (BC). Again, a systematic difference in band-crossing frequencies is observed between odd-N and even-N Er, Yb, Hf, and W nuclei, but in the BC case, it is opposite to the AB neutron-number dependence. These results are discussed in terms of a reduction of neutron pairing correlations at high rotational frequencies and of the effects of Pauli blocking on the pairing field by higher-seniority configurations. Also playing a significant role are the changes in deformation with proton and neutron numbers, the changes in location of single-particle orbitals as a function of quadrupole deformation, and the position of the Fermi surface with regard to the various ω components of the neutron i13/2 shell