Programmatic feasibility of dried blood spots for the virological follow-up of patients on antiretroviral treatment in Nord Kivu, Democratic Republic of the Congo

Background:As part of its policy to shift monitoring of antiretroviral therapy (ART) to primary health care (PHC) workers, the Ministry of Health of the Democratic Republic of Congo (DRC) tested the feasibility of using dried blood spots (DBS) for viral load (VL) quantification and genotypic drug resistance testing in off-site high-throughput laboratories.Methods:DBS samples from adults on ART were collected in 13 decentralized PHC facilities in the Nord-Kivu province and shipped during program quarterly supervision to a reference laboratory 2000 km away, where VL was quantified with a commercial assay (m2000rt, Abbott). A second DBS was sent to a World Health Organization (WHO)-accredited laboratory for repeat VL quantification on a subset of samples with a generic assay (Biocentric) and genotypic drug resistance testing when VL >1000 copies per milliliter.Findings:Constraints arose because of an interruption in national laboratory funding rather than to technical or logistic problems. All samples were assessed by both VL assays to allow ART adjustment. Median DBS turnaround time was 37 days (interquartile range: 9-59). Assays performed unequally with DBS, impacting clinical decisions, quality assurance, and overall cost-effectiveness. Based on m2000rt or generic assay, 31.3% of patients were on virological failure (VF) and 14.8% presented resistance mutations versus 50.3% and 15.4%, respectively.Conclusion:This study confirms that current technologies involving DBS make virological monitoring of ART possible at PHC level, including in challenging environments, provided organizational issues are addressed. Adequate core funding of HIV laboratories and adapted choice of VL assays require urgent attention to control resistance to ART as coverage expands

Recent Decisions

ACT OF STATE--Act of State Doctrine Not a Bar to Adjudication of a Counterclaim Robert M. Erickson ========================== ADMIRALTY--Ship Mortgage Act of 1920--Deficiency Judgment against Mortgagor in Personam Not Precluded by State Law when Vessels were Sold at Public Foreclosure Auction without Prior Appraisal Jack F. Stringham, II =========================== ALIENS--Immigration and Naturalization--Restriction of Commuter Aliens\u27 Access to Domestic Employment by Attorney General is Abuse of Discretion Alan Marchisotto ================= EXTRADITION--Principle of Specialty--Specialty does not Preclude Prosecution for Similar Offense when Asylum Nation Would Not Consider it a Breach of Faith Attorney General of the United States, 462 F.2d 475 (2d Cir. 1972),petition for cert. filed, 41 U.S.L.W. 3114 (U.S. Aug. 26, 1972) (No.332). James T. Campbell ========================= JURISDICTION--Forum Selection Clauses--United States Courts will Enforce Forum Selection Clauses in International Towage Contracts Absent Exceptional Circumstances Ralph C. Oser ======================== TAXATION--Foreign Tax Credit--Foreign Income Tax Credit Under Section 901 Allowable Only for Taxes Imposed on Net Gain or Profit David A. Boillo

A Unified Theoretical Description of the Thermodynamical Properties of Spin Crossover with Magnetic Interactions

After the discovery of the phenomena of light-induced excited spin state trapping (LIESST), the functional properties of metal complexes have been studied intensively. Among them, cooperative phenomena involving low spin-high spin (spin-crossover) transition and magnetic ordering have attracted interests, and it has become necessary to formulate a unified description of both phenomena. In this work, we propose a model in which they can be treated simultaneously by extending the Wajnflasz-Pick model including a magnetic interaction. We found that this new model is equivalent to Blume-Emery-Griffiths (BEG) Hamiltonian with degenerate levels. This model provides a unified description of the thermodynamic properties associated with various types of systems, such as spin-crossover (SC) solids and Prussian blue analogues (PBA). Here, the high spin fraction and the magnetization are the order parameters describing the cooperative phenomena of the model. We present several typical temperature dependences of the order parameters and we determine the phase diagram of the system using the mean-field theory and Monte Carlo simulations. We found that the magnetic interaction drives the SC transition leading to re-entrant magnetic and first-order SC transitions.Comment: 30pages, 11figure

Overview of the recent operation of the AAC and LEAR for the low-energy antiproton physics programme

This paper reviews the recent performance of the AAC and LEAR. Activities on the AAC include the successful exploitation of a magnetic horn as an antiproton collector lens and an energy-saving mode of operation, which has been possible since 1992, when LEAR became the only client of the AAC. LEAR worked in its full momentum range between 100 MeV/c and 2 GeV/c, with perform-ance (intensities, ejection modes and spill length) exceeding the design specifications. Improvements are described, which contributed to the quality of the beam delivered to experiments. The reliability and availability of the antiproton machines are also discussed

DNA adducts in fish following an oil spill exposure

On 12 December 1999, one third of the load of the Erika tanker, amounting to about 10,000 t crude oil flowed into sea waters close to the French Atlantic Coast. This oil contained polycyclic aromatic compounds (PAC) that are known to be genotoxic. Genotoxic effects induce DNA adducts formation, which can thus be used as pollution biomarkers. Here, we assessed the genotoxic impact of the “Erika” oil spill by DNA adducts detection in the liver of immature fishes (Solea solea) from four locations of the French Brittany coasts. Two months after the spill, a high amount of DNA adducts was found in samples from all locations, amounting to 92–290 DNA adduct per 109 nucleotides. Then total DNA adduct levels decreased to reach about 50 adducts per 109 nucleotides nine months after the spill. In vitro experiments using human cell cultures and fish liver microsomes evidence the genotoxicity of the Erika fuel. They also prove the formation of reactive species able to create DNA adducts. Furthermore, in vitro and in vivo DNA adducts fingerprints are similar, thus confirming that DNA adducts are a result of the oil spill

Divergent HIV-1 strains (CRF92_C2U and CRF93_cpx) co-circulating in the Democratic Republic of the Congo: Phylogenetic insights on the early evolutionary history of subtype C.

Molecular epidemiological studies revealed that the epicenter of the HIV pandemic was Kinshasa, the capital city of the Democratic Republic of the Congo (DRC) in Central Africa. All known subtypes and numerous complex recombinant strains co-circulate in the DRC. Moreover, high intra-subtype diversity has been also documented. During two previous surveys on HIV-1 antiretroviral drug resistance in the DRC, we identified two divergent subtype C lineages in the protease and partial reverse transcriptase gene regions. We sequenced eight near full-length genomes and classified them using bootscanning and likelihood-based phylogenetic analyses. Four strains are more closely related to subtype C although within the range of inter sub-subtype distances. However, these strains also have small unclassified fragments and thus were named CRF92_C2U. Another strain is a unique recombinant of CRF92_C2U with an additional small unclassified fragment and a small divergent subtype A fragment. The three remaining strains represent a complex mosaic named CRF93_cpx. CRF93_cpx have two fragments of divergent subtype C sequences, which are not conventional subtype C nor the above described C2, and multiple divergent subtype A-like fragments. We then inferred the time-scaled evolutionary history of subtype C following a Bayesian approach and a partitioned analysis using major genomic regions. CRF92_C2U and CRF93_cpx had the most recent common ancestor with conventional subtype C around 1932 and 1928, respectively. A Bayesian demographic reconstruction corroborated that the subtype C transition to a faster phase of exponential growth occurred during the 1950s. Our analysis showed considerable differences between the newly discovered early-divergent strains and the conventional subtype C and therefore suggested that this virus has been diverging in humans for several decades before the HIV/M diversity boom in the 1950s

An Antiproton Decelerator in the CERN PS Complex

The present CERN PS low-energy antiproton complex involves 4 machines to collect, cool, decelerate and supply experiments with up to 1010 antiprotons per pulse and per hour of momenta ranging from 0.1 to 2 GeV/c. In view of a possible future physics programme requiring low energy antiprotons, mainly to carry out studies on antihydrogen, a simplified scheme providing at low cost antiprotons at 100 MeV/c has been studied. It requires only one machine, the present Antiproton Collector (AC) converted into a cooler and decelerator (Antiproton Decelerator, AD) and delivering beam to experiments in the hall of the present Antiproton Accumulator Complex (AAC) [1]. This paper describes the feasibility study of such a scheme [2]

The antiproton decelerator (AD), a simplified antiproton source (feasibility study)

In view of a possible future physics programme concerning antihydrogen a simplified scheme for the provision of antiprotons of a few MeV has been studied. It uses the present target area and the modified Antiproton Collector (AC) in its present location. In this report all the systems are reviewed and their modifications discussed