The potential impact of new generation molecular point-of-care tests on gonorrhoea and chlamydia in a setting of high endemic prevalence

Sexual Health ◽  
2013 ◽  
Vol 10 (4) ◽  
pp. 348 ◽  
Author(s):  
Ben B. Hui ◽  
David P. Wilson ◽  
James S. Ward ◽  
Rebecca J. Guy ◽  
John M. Kaldor ◽  
...  
Keyword(s):  
Point Of Care ◽  
Treatment Strategies ◽  
High Sensitivity ◽  
Indigenous Communities ◽  
Great Promise ◽  
Screening Methods ◽  
Sexually Transmissible Infections ◽  
Screening Coverage ◽  
New Generation ◽  
The Impact

Background Despite the availability of testing and treatment, bacterial sexually transmissible infections (STIs) continue to occur at endemic levels in many remote Indigenous communities in Australia. New generation molecular point-of-care (POC) tests have high sensitivity, comparable with conventional diagnostic tests, and have the potential to increase the impact of STI screening. Methods: We developed mathematical models of gonorrhoea (Neisseria gonorrhoeae) and chlamydia (Chlamydia trachomatis) transmission in remote Indigenous communities in Australia to evaluate screening and treatment strategies that utilise POC tests. Results: The introduction of POC testing with 95% sensitivity could reduce the prevalence of gonorrhoea and chlamydia from 7.1% and 11.9% to 5.7% and 8.9%, respectively, under baseline screening coverage of 44% per year. If screening coverage is increased to 60% per year, prevalence is predicted to be reduced to 3.6% and 6.7%, respectively, under conventional testing, and further reduced to 1.8% and 3.1% with the introduction of POC testing. Increasing screening coverage to 80% per year will result in a reduction in the prevalence of gonorrhoea and chlamydia to 0.6% and 1.5%, respectively, and the virtual elimination of both STIs if POC testing is introduced. Conclusions: Modelling suggests that molecular POC tests of high sensitivity have great promise as a public health strategy for controlling chlamydia and gonorrhoea. However, evaluation of the cost-effectiveness of POC testing needs to be made before widespread implementation of this technology can be considered.

Could point-of-care testing be effective for reducing the prevalence of trichomoniasis in remote Aboriginal communities?

Sexual Health ◽  
2014 ◽  
Vol 11 (4) ◽  
pp. 370
Author(s):  
Ben B. Hui ◽  
James Ward ◽  
Louise Causer ◽  
Rebecca J. Guy ◽  
Matthew G. Law ◽  
...  
Keyword(s):  
Mathematical Modelling ◽  
Older Women ◽  
Point Of Care ◽  
Indigenous Communities ◽  
Treatment Programs ◽  
Point Of Care Testing ◽  
Aboriginal Communities ◽  
Sexually Transmissible Infections ◽  
High Prevalence ◽  
The Impact

High prevalence of trichomoniasis is reported for many remote Indigenous communities despite intensive screening and treatment programs. Mathematical modelling has previously been used to show that point-of-care (POC) testing for gonorrhoea and chlamydia has the potential to increase the impact of screening in reducing the prevalence of these sexually transmissible infections. The study was extended to estimate the impact of a rapid POC test for trichomoniasis. The results suggest that POC testing in place of conventional testing will also provide additional reductions in trichomoniasis prevalence. However, more emphasis should be placed on testing for trichomoniasis in older women due to the high prevalence observed in this group.

Abstract 14661: High Sensitive Troponin Elevation Pattern in Covid-19 Era

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Alessandro Maino ◽  
Enrico Di Stasio ◽  
Maria Chiara Grimaldi ◽  
Luigi Cappannoli ◽  
Erica Rocco ◽  
...  
Keyword(s):  
Disease Severity ◽  
Demographic Data ◽  
Fatal Outcome ◽  
Treatment Strategies ◽  
High Sensitivity ◽  
Laboratory Findings ◽  
Reference Limit ◽  
Care Information ◽  
Upper Reference Limit ◽  
The Impact

Introduction: Coronavirus disease 2019 (COVID-19) is a pandemic disease that has caused a public health emergency due to its high rapid spread, to the high mortality rate, and the high percentage of patients requiring hospitalization and intensive care . Information regarding the impact of cardiovascular complication on fatal outcome is scarce. Purpose: To compare the levels of hs-Tn between patients affected by SARS-CoV-2 admitted to our hospital in the period February 20-April 9, 2020 versus the general population COVID free. Furthermore, we studied the dependence of hs-Tn levels in SARS-CoV-2 patients on disease severity and on other epidemiological, clinical and laboratory parameters. Methods: This retrospective single-center study analyzed all patients in whom hs-TnI was determined at the Policlinico A.Gemelli (Rome, Italy) from 20 February 2020 to 09 April 2020. One hundred-seventy of these patients received SARS-CoV-2 diagnosis. Demographic data, laboratory findings, comorbidities, and treatments were collected and analyzed in patients with COVID 19. Results: In our study, the population affected by SARS-CoV-2 (n=170) showed a significant association between disease severity and troponin levels (median [range] = 4.0 [<2.4-227.0], 13.5 [<2.4-545.0] and 34.0 [<2.4-45345.0], p<0.001, for mild, severe and critical state, respectively). Moreover, 27 subjects out of 170 (16%) showed high sensitivity troponin values higher than the 99 percentile upper reference limit stratified among previously defined severity classes as follows n=2 (2.4%), n=7 (15.9%) and n=18 (45.0%), respectively. Conclusions: The distribution of the troponin values greater than the cut-off in the SARS-CoV-2 population indicates a myocardial suffering independently related to COVID19 infection. This phenomenon may partially explain the high risk of adverse outcome in COVID-19 patients with underlying CVD. Therefore, it may be reasonable to triage patients with COVID-19 according to the presence of underlying CVD and evidence of myocardial injury for prioritized and personalized treatment strategies.

scholarly journals Antibiotic resistance detection is essential for gonorrhoea point-of-care testing: A mathematical modelling study

2017 ◽  
Author(s):  
Stephanie M. Fingerhuth ◽  
Nicola Low ◽  
Sebastian Bonhoeffer ◽  
Christian L. Althaus
Keyword(s):  
Antibiotic Resistance ◽  
Clinical Pathways ◽  
Point Of Care ◽  
High Sensitivity ◽  
Nucleic Acid Amplification ◽  
Transmission Model ◽  
Antibiotic Resistant ◽  
Sex With Men ◽  
The Impact ◽  
Resistance Detection

AbstractAntibiotic resistance is threatening to make gonorrhoea untreatable. Point-of-care (POC) tests that detect resistance promise individually tailored treatment, but might lead to more treatment and higher levels of resistance. We investigate the impact of POC tests on antibiotic-resistant gonorrhoea. We used data about the prevalence and incidence of gonorrhoea in men who have sex with men (MSM) and heterosexual men and women (HMW) to calibrate a mathematical gonorrhoea transmission model. With this model, we simulated four clinical pathways for the diagnosis and treatment of gonorrhoea: POC test with (POC + R) and without (POC − R) resistance detection, culture, and nucleic acid amplification tests (NAATs). We calculated the proportion of resistant infections, cases averted after 5 years, and compared how fast resistant infections spread in the populations. The proportion of resistant infections after 30 years is lowest for POC + R (median MSM: 0.18%, HMW: 0.12%), and increases for culture (MSM: 1.19%, HWM: 0.13%), NAAT (MSM: 100%, HMW: 99.27%), and POC − R (MSM: 100%, HMW: 99.73%). NAAT leads to 36 366 (median MSM) and 1 228 (median HMW) observed cases after 5 years. When compared with NAAT, POC + R results in most cases averted after 5 years (median MSM: 3 353, HMW: 118 per 100 000 persons). POC tests that detect resistance with intermediate sensitivity slow down resistance spread more than NAAT. POC tests with very high sensitivity for the detection of resistance are needed to slow down resistance spread more than using culture. POC with high sensitivity to detect antibiotic resistance can keep gonorrhoea treatable longer than culture or NAAT. POC tests without reliable resistance detection should not be introduced because they can accelerate the spread of antibiotic-resistant gonorrhoea.

scholarly journals Era mejor cuando éramos ilegales (it was better when we were illegals): Indigenous people, the State and public interest indigenous radio stations in Colombia

2019 ◽  
Vol 4 (3) ◽  
pp. 28-42
Author(s):  
Diego Mauricio Cortés
Keyword(s):  
Indigenous Communities ◽  
State Intervention ◽  
Careful Consideration ◽  
Unintended Consequences ◽  
State Legislation ◽  
Radio Stations ◽  
Indigenous Media ◽  
Political Struggles ◽  
New Generation ◽  
The Impact

This article discusses the intervention of the Colombian State in the development of indigenous radio stations, focusing on the case of the Misak and Nasa communities. As shown, these radio stations have had different contributions in these indigenous communities, such as forging a new generation of leaders, promoting their languages, and encouraging political mobilisation. However, these media projects have also brought new challenges for these communities, calling for a more careful consideration of the complexities of state intervention in community radio projects. This article contributes to a better understanding of the impact of state intervention in indigenous media, by focusing on three main features that illustrate some of the unintended consequences of these projects: 1) contradictory state legislation that, instead of empowering indigenous media projects, tamed their political potential; 2) the natural role of radio stations as a modern disruptors (Appadurai, 1996) that may have positives as well as negative consequence in the changes they generate in indigenous communities; and 3) the internal political struggles within these indigenous communities.

scholarly journals Highly Specific and Sensitive Detection of Yersinia pestis by Portable Cas12a-UPTLFA Platform

2021 ◽  
Vol 12 ◽  
Author(s):  
Yang You ◽  
Pingping Zhang ◽  
Gengshan Wu ◽  
Yafang Tan ◽  
Yong Zhao ◽  
...  
Keyword(s):  
Nucleic Acid ◽  
Yersinia Pestis ◽  
Rapid Detection ◽  
Detection Method ◽  
Detection System ◽  
Point Of Care ◽  
High Sensitivity ◽  
Nucleic Acid Detection ◽  
Great Promise ◽  
High Background

The recent discovery of collateral cleavage activity of class-II clustered regularly interspaced short palindromic repeats–CRISPR-associated protein (CRISPR-Cas) makes CRISPR-based diagnosis a potential high-accuracy nucleic acid detection method. Colloidal gold-based lateral flow immunochromatographic assay (LFA), which has been combined with CRISPR/Cas-based nucleic detection, usually associates with drawbacks of relative high background and the subjectivity in naked-eye read-out of the results. Here, we developed a novel system composed of Cas12a-based nucleic acid detection and up-converting phosphor technology (UPT)-based LFA (UPT–LFA), termed Cas12a-UPTLFA. We further demonstrated the utility of this platform in highly sensitive and specific detection of Yersinia pestis, the causative agent of the deadly plague. Due to high infectivity and mortality, as well as the potential to be misused as bioterrorism agent, a culture-free, ultrasensitive, specific, and rapid detection method for Y. pestis has long been desired. By incorporating isothermal recombinase polymerase amplification, the Cas12a-UPTLFA we established can successfully detect genomic DNA of Y. pestis as low as 3 attomolar (aM) and exhibited high sensitivity (93.75%) and specificity (90.63%) for detection of spiked blood samples with a detection limit of 102 colony-forming unit per 100 μl of mouse blood. With a portable biosensor, Cas12a-UPTLFA assay can be operated easily by non-professional personnel. Taken together, we have developed a novel Cas12a-UPTLFA platform for rapid detection of Y. pestis with high sensitivity and specificity, which is portable, not expensive, and easy to operate as a point-of-care method. This detection system can easily be extended to detect other pathogens and holds great promise for on-site detection of emerging infectious pathogens.

scholarly journals Understanding Localness of Built Form at the Urban Scale: Case of Karachi, Pakistan

2017 ◽  
Vol 2 (1) ◽  
pp. 39
Author(s):  
Suneela Ahmed
Keyword(s):  
Indigenous Communities ◽  
Research Approach ◽  
Structured Interviews ◽  
The West ◽  
Built Form ◽  
Observation Methods ◽  
Inductive Research ◽  
Identity Crises ◽  
New Generation ◽  
The Impact

Many cities in the developing world aspire to imitate cities of the West in their built form, since for them this represents ‘modernism’ and the future. Pakistan is a young country and the contribution of a new generation of architects and planners has been inspired by the West, in the post-modern traditions; and not informed by the local cultural, social, and physical aspects of the society. Karachi, within Pakistan, has recently seen the construction of a number of buildings and urban design projects that conform to the international concepts of entrepreneurship and innovation and are a response to the desire of politicians to create a global image for the city. Using the Urdu word maqamiat in relation to the built form, this research assesses what it means for a city to be local in the context of Karachi, being specific, having particular variables impacting the built form, but dealing with similar issues of identity crises as other formally colonized nations. A combination of deductive and inductive research approach that arches over mixed methods is used in order to reveal the nature and value of maqamiat in the built form. Semi structured interviews, focus groups, urban morphological documentation, archive review, and personal observation methods have been used for data collecting. Content, narrative, and focus group analyses are used to interpret data. This research is part of a PhD that was undertaken at Oxford Brookes University from 2012- 2016. The research postulates lessons from its study of local processes of built form production about the value given to local places by indigenous communities and the impact of global forces through image ability, aesthetics, and style.

scholarly journals Point-of-care tests for sexually transmissible infections: what do ‘end users' want?

Sexual Health ◽  
2013 ◽  
Vol 10 (6) ◽  
pp. 541 ◽  
Author(s):  
Anne M. Rompalo ◽  
Yu-Hsiang Hsieh ◽  
Terry Hogan ◽  
Mathilda Barnes ◽  
Mary Jett-Goheen ◽  
...  
Keyword(s):  
Qualitative Content Analysis ◽  
Point Of Care ◽  
High Sensitivity ◽  
Advantages And Disadvantages ◽  
Point Of Care Test ◽  
Home Test ◽  
Sexually Transmissible Infections ◽  
Important Quality ◽  
Point Of Care Tests ◽  
At Home

Background Clinicians and developers identify sensitivity as an important quality in a point-of-care test (POCT) for sexually transmissible infections (STIs). Little information exists regarding what patients want for STI POCTs. Methods: A qualitative study, encompassing five focus groups among attendees of STI and adolescent health centres in Baltimore, Maryland, and Cincinnati, Ohio, were conducted between March 2008 and April 2009. Discussion topics included advantages and disadvantages of having a POCT, perceived barriers to using POCTs in the clinic setting and at home, priorities for the development of new POCTs for STIs, and envisioned characteristics of an ideal POCT. All discussions were recorded and transcribed. A qualitative content analysis was performed to examine frequencies or patterns of recurring codes, which were regrouped and indexed to identify salient themes. Results: Patients attending STI and adolescent outpatient clinics are in favour of diagnostic tests that are rapid, easy to read and simple to use. Home testing options for POCTs were acceptable and provided better confidentiality, privacy and convenience, but clinic-based POCTs were also acceptable because they offer definitive results and ensure immediate treatment. Barriers to home POCTs centred on cost and the ability to read and perform the test correctly at home. Opinions did not differ by patient ethnicity, except that Hispanic participants questioned the reliability of home test results, wanted high sensitivity and desired bilingual instructions. Conclusions: Patients attending STI and adolescent medical centres are in favour of STI POCTs if they are affordable, rapid, easy to read and simple to use.

scholarly journals Understanding Localness of Built Form at the Urban Scale: Case of Karachi, Pakistan

2017 ◽  
Vol 2 (1) ◽  
pp. 39
Author(s):  
Suneela Ahmed
Keyword(s):  
Indigenous Communities ◽  
Research Approach ◽  
Structured Interviews ◽  
The West ◽  
Built Form ◽  
Observation Methods ◽  
Inductive Research ◽  
Identity Crises ◽  
New Generation ◽  
The Impact

Many cities in the developing world aspire to imitate cities of the West in their built form, since for them this represents ‘modernism’ and the future. Pakistan is a young country and the contribution of a new generation of architects and planners has been inspired by the West, in the post-modern traditions, and not informed by the local cultural, social and physical aspects of the society. Karachi, within Pakistan, has recently seen the construction of a number of buildings and urban design projects that conform to the international concepts of entrepreneurship and innovation, and are a response to the desire of politicians to create a global image for the city.Using the Urdu word maqamiat in relation to the built form, this research assesses what it means for a city to be local in the context of Karachi, being specific, having particular variables impacting the built form, but dealing with similar issues of identity crises as other formally colonized nations. A combination of deductive and inductive research approach that arches over mixed methods is used, in order to reveal the nature and value of maqamiat of built form. Semi structured interviews, focus groups, urban morphological documentation, archive review and personal observation methods have been used for data collecting. Content, narrative and focus group analyses are used to interpret data.This research is part of a PhD that was undertaken at Oxford Brookes University from 2012- 2016. The research postulates lessons from its study of local processes of built form production, the value given to local places by indigenous communities and the impact of global forces through imageability, aesthetics and style.

scholarly journals Early detection of elevated cardiac biomarkers to optimise risk stratification in patients with COVID-19

Heart ◽  
2020 ◽  
Vol 106 (19) ◽  
pp. 1512-1518 ◽  
Author(s):  
Giulio G. Stefanini ◽  
Mauro Chiarito ◽  
Giuseppe Ferrante ◽  
Francesco Cannata ◽  
Elena Azzolini ◽  
...  
Keyword(s):  
Early Detection ◽  
Risk Stratification ◽  
Hospital Admission ◽  
Troponin I ◽  
Treatment Strategies ◽  
High Sensitivity ◽  
Cardiac Biomarkers ◽  
Early Assessment ◽  
All Cause Mortality ◽  
The Impact

ObjectiveRisk stratification is crucial to optimise treatment strategies in patients with COVID-19. We aimed to evaluate the impact on mortality of an early assessment of cardiac biomarkers in patients with COVID-19.MethodsHumanitas Clinical and Research Hospital (Rozzano-Milan, Lombardy, Italy) is a tertiary centre that has been converted to the management of COVID-19. Patients with confirmed COVID-19 were entered in a dedicated database for cohort observational analyses. Outcomes were stratified according to elevated levels (ie, above the upper level of normal) of high-sensitivity cardiac troponin I (hs-TnI), B-type natriuretic peptide (BNP) or both measured within 24 hours after hospital admission. The primary outcome was all-cause mortality.ResultsA total of 397 consecutive patients with COVID-19 were included up to 1 April 2020. At the time of hospital admission, 208 patients (52.4%) had normal values for cardiac biomarkers, 90 (22.7%) had elevated both hs-TnI and BNP, 59 (14.9%) had elevated only BNP and 40 (10.1%) had elevated only hs-TnI. The rate of mortality was higher in patients with elevated hs-TnI (22.5%, OR 4.35, 95% CI 1.72 to 11.04), BNP (33.9%, OR 7.37, 95% CI 3.53 to 16.75) or both (55.6%, OR 18.75, 95% CI 9.32 to 37.71) as compared with those without elevated cardiac biomarkers (6.25%). A multivariate analysis identified concomitant elevation of both hs-TnI and BNP as a strong independent predictor of all-cause mortality (OR 3.24, 95% CI 1.06 to 9.93).ConclusionsAn early detection of elevated hs-TnI and BNP predicts mortality in patients with COVID-19. Cardiac biomarkers should be systematically assessed in patients with COVID-19 at the time of hospital admission in order to optimise risk stratification.

scholarly journals Potential for Point-of-Care Tests to Reduce Chlamydia-associated Burden in the United States: A Mathematical Modeling Analysis

2019 ◽  
Vol 70 (9) ◽  
pp. 1816-1823 ◽  
Author(s):  
Minttu M Rönn ◽  
Nicolas A Menzies ◽  
Thomas L Gift ◽  
Harrell W Chesson ◽  
Tom A Trikalinos ◽  
...  
Keyword(s):  
United States ◽  
Test Performance ◽  
Point Of Care ◽  
Credible Interval ◽  
The United States ◽  
Treatment Delay ◽  
Transmission Model ◽  
Screening Coverage ◽  
Point Of Care Tests ◽  
The Impact

Abstract Background Point-of-care testing (POCT) assays for chlamydia are being developed. Their potential impact on the burden of chlamydial infection in the United States, in light of suboptimal screening coverage, remains unclear. Methods Using a transmission model calibrated to data in the United States, we estimated the impact of POCT on chlamydia prevalence, incidence, and chlamydia-attributable pelvic inflammatory disease (PID) incidence, assuming status quo (Analysis 1) and improved (Analysis 2) screening frequencies. We tested the robustness of results to changes in POCT sensitivity, the proportion of patients getting treated immediately, the baseline proportion lost to follow-up (LTFU), and the average treatment delay. Results In Analysis 1, high POCT sensitivity was needed to reduce the chlamydia-associated burden. With a POCT sensitivity of 90%, reductions from the baseline burden only occurred in scenarios in which over 60% of the screened individuals would get immediate treatment and the baseline LTFU proportion was 20%. With a POCT sensitivity of 99% (baseline LTFU 10%, 2-week treatment delay), if everyone were treated immediately, the prevalence reduction was estimated at 5.7% (95% credible interval [CrI] 3.9–8.2%). If only 30% of tested persons would wait for results, the prevalence reduction was only 1.6% (95% CrI 1.1–2.3). POCT with 99% sensitivity could avert up to 12 700 (95% CrI 5000–22 200) PID cases per year, if 100% were treated immediately (baseline LTFU 20% and 3-week treatment delay). In Analysis 2, when POCT was coupled with increasing screening coverage, reductions in the chlamydia burden could be realized with a POCT sensitivity of 90%. Conclusions POCT could improve chlamydia prevention efforts if test performance characteristics are significantly improved over currently available options.

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