Indeterminate rapid HIV-1 test results among antenatal and postnatal mothers

The sensitivity and specificity of rapid HIV-1 tests may be altered during pregnancy and postpartum. We conducted a study to determine the prevalence and correlates of false-positive Abbott Determine and false-negative Uni-Gold rapid HIV-1 test results among antenatal and postnatal mothers attending a primary care clinic in Nairobi, Kenya. Mothers were tested for HIV-1 using Abbott Determine and non-reactive results were considered HIV-1 antibody negative. Reactive samples by Determine were re-tested by Uni-Gold. Vironostika HIV-1 and Uni-FORM II Enzyme-linked immunosorbent assays were used to confirm samples that had positive Abbott Determine and negative Uni-Gold. Among 2311 women who accepted HIV-1 testing, 1238 (54%) were tested antenatally and 1073 (46%) were tested postnatally. Of tested women, 274 (12%) women were reactive by Abbott Determine and on retesting with Uni-Gold 30 (11%) had indeterminate results. The prevalence of indeterminate results was significantly higher in antenatal women than in postnatal women (2% versus 1%, P = 0.03). In conclusion, indeterminate rapid HIV-1 test results are more common in the antenatal period and appropriate safeguards to confirm HIV-1 infection status should be implemented in antenatal programmes.

A randomized phase II trial of weekly docetaxel plus either cisplatin or oxaliplatin in patients with previously untreated advanced gastric cancer: Preliminary results

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Background: Docetaxel, in combination with cisplatin or oxaliplatin, has demonstrated efficacy against AGC. This randomized phase II trial evaluated two weekly docetaxel-based regimens to see which would be most promising according to objective response rate (ORR) as first-line therapy in AGC. Methods: Chemotherapy-naïve patients with measurable unresectable and/or metastatic gastric adenocarcinoma and a performance status ≤2 were randomly assigned to receive docetaxel (35 mg/m2) weekly on days 1 and 8 of a 21-day cycle plus either cisplatin (60 mg/m2 on day 1) (arm A) or oxaliplatin (120 mg/m2 on day 1) (arm B). Toxicity was assessed on days 1, 8, and 21 of each cycle, and response was evaluated every 2 cycles. Results: Between March 2007 and December 2008, 61 eligible patients entered. In Arm A, 29 patients were evaluable for objective response and 31 for safety. In Arm B, 28 patients were evaluable for objective response and 30 for safety. Median age was 52 years and disease status was comparable for both arms. Ten of 29 (34.5%) patients had a confirmed objective response in the arm A (95% confidence interval [CI] 17.1–51.8%) and 11 of 28 (39.2%) patients had a confirmed objective response in the arm B (95% CI 21.1- 57.2%). No significant difference was noted between the arms both for ORR (p=0.202) or for disease control (58.6% and 82.1%, respectively, p=0.082). Median progression free survival time was 4.4 month in the arm A and 4.3 months in the arm B (Hazard ratio = 0.936; 95% CI, 0.503–1.744; p = 0.836). There was no relevant difference in the occurrence of overall grade ¾ toxicity between the two arms (51.6% vs. 46.6%, respectively; p=0.800). Neutropenia was the most common grade 3/4 toxicity (32.3% vs. 36.6%, respectively). There was one treatment related death in Arm B. Conclusions: The preliminary results showed that both treatment arms have similar clinical efficacy as front-line treatment in AGC. Each regimen has a manageable tolerability profile. The accrual is ongoing.

No significant financial relationships to disclose.

Implementation of proven interventions in general medical inpatients: development and evaluation of a new quality indicator for drug therapy

BACKGROUND

Among adult general medical inpatients, there are numerous interventions whose benefits outweigh their risks. However, there are no published reports describing the overall use of such proven interventions in this population.

OBJECTIVES

To determine implementation rates of a broad range of interventions while accounting for valid reasons for non-use, predictors of implementation and feasibility of generating new indices to describe quality of care.

METHODS

Based on a review of current practice guidelines and clinical trials related to five common conditions, implementation rates of 17 interventions were assessed retrospectively. Subjects were a complete sample of 150 adults with target medical conditions discharged from general medical units at an urban community hospital.

RESULTS

The Ideal Intervention Index (3I), which described the proportion of ideal intervention opportunities that were implemented, was 0.74 (95% CI 0.70 to 0.78). The Justified Non-Use Index (JNUI), which described the proportion of all the interventions not implemented that were justified by a valid reason for non-use, was 0.49 (95% CI 0.41 to 0.55). Smoking cessation therapy in high-risk patients had the lowest indices (3I 0.30, 95% CI 0.00 to 0.60; JNUI 0.00), and aspirin for secondary stroke prevention had the highest (3I 1.0; JNUI 1.0).

CONCLUSIONS

Overall, proven interventions are underused among the patients studied, and the reasons for non-use are frequently not readily discernible. There is potential for improvement, but research is required to further investigate reasons for non-use. It is feasible to measure implementation rates of proven interventions as an indicator of quality of care using the indices developed.

Zero valent iron and clay mixtures for removal of trichloroethylene, chromium(VI), and nitrate

A series of batch experiments on free swell, hydraulic conductivity, and contaminant removal efficiency was performed for the combination of bentonite and zero valent iron (ZVI), in order to identify the optimal mixing ratio between bentonite and ZVI. The swell volume of the bentonite-ZVI mixtures did not change with increasing ZVI, and the hydraulic conductivity decreased as the ZVI increased. The reduction rates and removal efficiencies of trichloroethylene (TCE), Chromium(VI), and nitrate increased as ZVI content increased, while there was no practical difference in removal efficiencies between 30% and 100% of ZVI weight contents. Therefore, 30% of the ZVI content was used as the optimal amount in this research since the physical properties, such as swell volume and hydraulic conductivity, as well as the contaminant sorption and reduction were the most efficient. From Raman spectrophotometer analysis, peaks of magnetite, maghemite, and hematite were observed on the surfaces of the bentonites that had been used for the mixtures. Since iron oxides are strong adsorbers of contaminants and magnetites can facilitate the electron transfer of irons, these formations are beneficial for the long-term performance of the iron metals.

Characterization of indoor air quality using multiple measurements of nitrogen dioxide

Indoor air quality can be affected by indoor sources, ventilation, decay and outdoor levels. Although technologies exist to measure these factors, direct measurements are often difficult. The purpose of this study was to develop an alternative method to characterize indoor environmental factors by multiple indoor and outdoor measurements. Daily indoor and outdoor NO2 concentrations were measured for 30 consecutive days in 28 houses in Brisbane, Australia, and for 21 consecutive days in 37 houses in Seoul, Korea. Using a mass balance model and regression analysis, penetration factor (ventilation rate divided by the sum of ventilation rate and deposition constant) and source strength factor (source strength divided by the sum of ventilation rate and deposition constant) were calculated using multiple indoor and outdoor measurements. Subsequently, the ventilation rate and NO2 source strength were estimated. Geometric means of ventilation rate were 1.44 air change per hour (ACH) in Brisbane, assuming a residential NO2 deposition constant of 1.05/h, and 1.36 ACH in Seoul, with the measured residential NO2 deposition constant of 0.94/h. Source strengths of NO2 were 15.8 +/- 18.2 and 44.7 +/- 38.1 microg/m3/h in Brisbane and Seoul, respectively. In conclusion, indoor environmental factors were effectively characterized by this method using multiple indoor and outdoor measurements.