Evaluation of HIV testing algorithms in Ethiopia: the role of the tie-breaker algorithm and weakly reacting test lines in contributing to a high rate of false positive HIV diagnoses.

BACKGROUND: In Ethiopia a tiebreaker algorithm using 3 rapid diagnostic tests (RDTs) in series is used to diagnose HIV. Discordant results between the first 2 RDTs are resolved by a third 'tiebreaker' RDT. Médecins Sans Frontières uses an alternate serial algorithm of 2 RDTs followed by a confirmation test for all double positive RDT results. The primary objective was to compare the performance of the tiebreaker algorithm with a serial algorithm, and to evaluate the addition of a confirmation test to both algorithms. A secondary objective looked at the positive predictive value (PPV) of weakly reactive test lines. METHODS: The study was conducted in two HIV testing sites in Ethiopia. Study participants were recruited sequentially until 200 positive samples were reached. Each sample was re-tested in the laboratory on the 3 RDTs and on a simple to use confirmation test, the Orgenics Immunocomb Combfirm® (OIC). The gold standard test was the Western Blot, with indeterminate results resolved by PCR testing. RESULTS: 2620 subjects were included with a HIV prevalence of 7.7%. Each of the 3 RDTs had an individual specificity of at least 99%. The serial algorithm with 2 RDTs had a single false positive result (1 out of 204) to give a PPV of 99.5% (95% CI 97.3%-100%). The tiebreaker algorithm resulted in 16 false positive results (PPV 92.7%, 95% CI: 88.4%-95.8%). Adding the OIC confirmation test to either algorithm eliminated the false positives. All the false positives had at least one weakly reactive test line in the algorithm. The PPV of weakly reacting RDTs was significantly lower than those with strongly positive test lines. CONCLUSION: The risk of false positive HIV diagnosis in a tiebreaker algorithm is significant. We recommend abandoning the tie-breaker algorithm in favour of WHO recommended serial or parallel algorithms, interpreting weakly reactive test lines as indeterminate results requiring further testing except in the setting of blood transfusion, and most importantly, adding a confirmation test to the RDT algorithm. It is now time to focus research efforts on how best to translate this knowledge into practice at the field level. TRIAL REGISTRATION: Clinical Trial registration #: NCT01716299

Hydrothermal Synthesis, Characterization, and Sintering Behavior of Core-Shell Particles: A Principle Study on Lanthanum Strontium Cobaltite Coated with Nanosized Gadolinium Doped Ceria

In this work, nanostructured (La0.6Sr0.4)0.99CoO3 (LSC)-Ce0.8Gd0.2O1.9 (CGO) core-shell particles were prepared by precipitating CGO nanoparticles on the surface of LSC particles under hydrothermal conditions. The as-prepared core-shell particles were sintered by spark plasma sintering (SPS) and conventional sintering, and the microstructure evolution and densification behavior were studied. Dense microstructures were reached using both sintering methods at relatively low temperatures. In the case of SPS, the core-shell architecture was partially maintained and nano-structured CGO grains were formed, while conventional sintering led to the formation of larger CGO grains. This work covers a detailed characterization of (a) the individual LSC-CGO core-shell particles and (b) the composites after densification

Amyloid Precursor-Like Protein 2 deletion-induced retinal synaptopathy related to congenital stationary night blindness: structural, functional and molecular characteristics.

Amyloid precursor protein knockout mice (APP-KO) have impaired differentiation of amacrine and horizontal cells. APP is part of a gene family and its paralogue amyloid precursor-like protein 2 (APLP2) has both shared as well as distinct expression patterns to APP, including in the retina. Given the impact of APP in the retina we investigated how APLP2 expression affected the retina using APLP2 knockout mice (APLP2-KO). Using histology, morphometric analysis with noninvasive imaging technique and electron microscopy, we showed that APLP2-KO retina displayed abnormal formation of the outer synaptic layer, accompanied with greatly impaired photoreceptor ribbon synapses in adults. Moreover, APLP2-KO displayed a significant decease in ON-bipolar, rod bipolar and type 2 OFF-cone bipolar cells (36, 21 and 63 %, respectively). Reduction of the number of bipolar cells was accompanied with disrupted dendrites, reduced expression of metabotropic glutamate receptor 6 at the dendritic tips and alteration of axon terminals in the OFF laminae of the inner plexiform layer. In contrast, the APP-KO photoreceptor ribbon synapses and bipolar cells were intact. The APLP2-KO retina displayed numerous phenotypic similarities with the congenital stationary night blindness, a non-progressive retinal degeneration disease characterized by the loss of night vision. The pathological phenotypes in the APLP2-KO mouse correlated to altered transcription of genes involved in pre- and postsynatic structure/function, including CACNA1F, GRM6, TRMP1 and Gα0, and a normal scotopic a-wave electroretinogram amplitude, markedly reduced scotopic electroretinogram b-wave and modestly reduced photopic cone response. This confirmed the impaired function of the photoreceptor ribbon synapses and retinal bipolar cells, as is also observed in congenital stationary night blindness. Since congenital stationary night blindness present at birth, we extended our analysis to retinal differentiation and showed impaired differentiation of different bipolar cell subtypes and an altered temporal sequence of development from OFF to ON laminae in the inner plexiform layer. This was associated with the altered expression patterns of bipolar cell generation and differentiation factors, including MATH3, CHX10, VSX1 and OTX2. These findings demonstrate that APLP2 couples retina development and synaptic genes and present the first evidence that APLP2 expression may be linked to synaptic disease

Oxygen permeation flux through 10Sc1YSZ-MnCo₂O₄ asymmetric membranes prepared by two-step sintering

Asymmetric membranes based on a dual phase composite consisting of (Y2O3)0.01(Sc2O3)0.10(ZrO2)0.89 (10Sc1YSZ) as ionic conductor and MnCo2O4 as electronic conductor were prepared and characterized with respect to sinterability, microstructure and oxygen transport properties. The composite membranes were prepared by tape casting, lamination and fired in a two-step sintering process. Microstructural analysis showed that a gastight thin membrane layer with the desired ratio of ionic/electronic conducting phases could be fabricated. Oxygen permeation fluxes across the 10SclYSZ/MnCo2O4 (70/30 vol%) composite membrane were measured from 750 to 940 degrees C using air or pure oxygen as feed gases and N2 or CO2 as sweep gases. Fluxes up to 2.3 mlN min-1 cm-2 were obtained for the 7 μm thick membrane. A degradation test over 1730 h showed an initial degradation of 21% during the first 1100 h after which stable performance was achieved. The observed degradation is attributed to coarsening of the infiltrated catalyst. (C) 2016 Elsevier B.V. All rights reserved

Stability and performance of robust dual-phase (ZrO₂)_0.89(Y₂O₃)_0.01(Sc₂O₃)_0.10-Al_0.02Zn_0.98O_1.01 oxygen transport membranes

Dual-phase composite oxygen transport membranes consisting of 50 vol% Al0.02Zn0.98O1.01 and 50 vol% (ZrO2)0.89(Y2O3)0.01(Sc2O3)0.10 were successfully developed and tested. The applicability of the membrane in oxy-fuel power plants schemes involving direct exposure to flue gas was evaluated by exposing the membrane to gas streams containing CO2, SO2, H2O and investigating possible reactions between the membrane material and these gases. The analyses of the exposed composites by x-ray diffraction (XRD), x-ray fluorescence (XRF), attenuated total reflection Fourier transform infrared spectroscopy (ATR-FTIR), and Raman spectroscopy revealed excellent stability. Additionally, an electrical conductivity measurement over 900 h confirmed that the composite is stable under prolonged exposure to CO2. However, an instability of the dual-phase membrane under oxygen partial pressures below PO2~10−4 atm. was found. Oxygen permeation tests on a 1 mm thick self-standing membrane resulted in an oxygen flux of 0.33 mLN min−1 cm−2 at 925 °C in air/N2. Stability tests in CO2 with 3 vol% O2 demonstrated the potential for the use of 10Sc1YSZ-AZO dual-phase membranes in oxy-combustion processes involving direct exposure to flue gas

Exploring the Processing of Tubular Chromite- and Zirconia-Based Oxygen Transport Membranes

Tubular oxygen transport membranes (OTMs) that can be directly integrated in high temperature processes have a large potential to reduce CO2 emissions. However, the challenging processing of these multilayered tubes, combined with strict material stability requirements, has so far hindered such a direct integration. We have investigated if a porous support based on (Y2O3)0.03(ZrO2)0.97 (3YSZ) with a dense composite oxygen membrane consisting of (Y2O3)0.01(Sc2O3)0.10(ZrO2)0.89 (10Sc1YSZ) as an ionic conductor and LaCr0.85Cu0.10Ni0.05O3−δ (LCCN) as an electronic conductor could be fabricated as a tubular component, since these materials would provide outstanding chemical and mechanical stability. Tubular components were made by extrusion, dip coating, and co-sintering, and their chemical and mechanical integrity was evaluated. Sufficient gas permeability (≥10−14 m2) and mechanical strength (≥50 MPa) were achieved with extruded 3YSZ porous support tubes. The high co-sintering temperature required to densify the 10ScYSZ/LCCN membrane on the porous support, however, causes challenges related to the evaporation of chromium from the membrane. This chemical degradation caused loss of the LCCN electronic conducting phase and the formation of secondary lanthanum zirconate compounds and fractures. LCCN is therefore not suitable as the electronic conductor in a tubular OTM, unless means to lower the sintering temperature and reduce the chromium evaporation are found that are applicable to the large-scale fabrication of tubular components

Calibration of the CMS Drift Tube Chambers and Measurement of the Drift Velocity with Cosmic Rays

Peer reviewe