bluuebunny/crossref_metadata_2025 huggingface dataset:
Distributions of reverberation time measurements from restaurants of different Layouts
Authors: Anderson Victoria R. , Smith Kieren H. , Wang Lily M.
Published: April 2019

The purpose of this research is to determine how reverberation time differs spatially in restaurants with different seating arrangements such as spaces with one main dining room versus spaces with several connected dining areas branching off a main area. The physical layouts of a number of restaurants were spatially recorded, and impulse responses were taken at set interval locations throughout the unoccupied restaurants. Reverberation times have been calculated from the impulse responses and spatially mapped throughout the rooms in order to visually understand the distributions. The average reverberation time and standard deviations in each restaurant are presented and compared to similar data calculated previously for classrooms (Peng et al., 2012). Sound levels have also been logged from each restaurant during occupied times, and relationships between sound levels in an area and local reverberation time are explored.
Interpretability and generalizability of a one-dimensional convolutional neural network method for hepatic steatosis characterization
Authors: Han Aiguo , Zhang Yingzhen N. , Andre Michael P. , Loomba Rohit , Erdman John W. , Sirlin Claude B. , O'Brien W. D.
Published: April 2019

Nonalcoholic fatty liver disease (NAFLD) affects 25% of the population globally. We developed a one-dimensional convolutional neural network (1-D CNN) method for the ultrasound tissue characterization using radio-frequency (RF) data and demonstrated its potential for the liver fat classification and quantification. We investigate herein the interpretability and generalizability of the method to understand why it works, and whether the performance is affected by settings, transducers, and platforms. We studied under various conditions the performances of 1-D CNN for predicting steatosis using magnetic resonance imaging-estimated proton density fat fraction (MRI-PDFF) as reference (steatosis: PDFF > 5%). Three datasets were used, each containing ultrasound RF data acquired from adults and same-day MRI-PDFF estimates: (1) 200 normal and NAFLD participants scanned using the Siemens S2000 ultrasound system with the 4C1 transducer (1–4 MHz); (2) 87 participants with known/suspected NAFLD scanned using Siemens S3000 with the 4C1 and/or 6C1HD transducers (1.5–6 MHz); and (3) 46 participants with known/suspected NAFLD scanned using GE Logiq e9 with the C1-6 transducer (1–6 MHz). The 1-D CNN method is generalizable among various instrumentation settings (e.g., focal depth, time gain compensation), betweentransducers of similar frequencies, between platforms, but not between the fundamental and tissue harmonic image modes. [Work supported by R01DK106419.]
Etiology of the color Doppler twinkling artifact on kidney stones
Authors: Zinck Scott A.
Published: April 2019

Rapid Doppler shifts highlight some kidney stones with a rapid change in color in ultrasound imaging which is called the “twinkling artifact.” Many hypotheses exist to describe the mechanism of twinkling, including the hypothesis that microbubbles are stabilized in crevices on the surface of kidney stones. The objective is to evaluate the distribution of stable microbubbles on kidney stone surfaces with humidity-controlled scanning electron microscopy (ESEM) and determine whether any sub-surface characteristics as assessed with micro-computed tomography (µCT) may contribute to twinkling. A Verasonics® research ultrasound system with the Verasonics L22-14 and Philips/ATL L7-4 and C5-2 transducers quantified twinkling. Results show a correlation between voids within kidney stones and the locations of twinkling on the stone surface. These voids had a calculated free-field Minneart resonant frequency of 3–9 MHz depending on the size. ESEM revealed that surfaces that twinkled had more crevices with radii corresponding to bubbles with a free-field resonant frequency of 3–7 MHz. These results suggest that internal voids and surface crevices contribute to the twinkling artifact on kidney stones.
The effect of crystal chemical composition on the color Doppler ultrasound twinkling artifact
Authors: Rokni Eric , Zinck Scott A. , Simon Julianna C.
Published: April 2019

The color Doppler ultrasound twinkling artifact, or localized areas of rapid color shifts, has been used to aid in the diagnosis of kidney stones. Gallstones and some atherosclerotic plaques have also been shown to twinkle, suggesting that crystals, regardless of chemical composition, may harbor the stable microbubbles that are hypothesized to cause twinkling. Here, uric acid, cholesterol, and calcium phosphate crystals, which are often present in sites of pathological biomineralization, were grown in the lab using previously developed techniques and imaged with the Verasonics® research ultrasound system using Philips/ATL P4-2 and Verasonics L22-14 transducers. The magnitude of the Doppler signals was quantified and compared amongst the three crystal chemical compositions. Preliminary results show that all three crystal types displayed twinkling with the strongest magnitude appearing in the cholesterol crystals. These results suggest that twinkling is very sensitive in the presence of crystals regardless of the chemical composition. Future work will explore the use of histotripsy to mechanically fractionate crystals as a novel treatment for pathological biomineralization.
Sound speed measurements in Kentucky bourbon whiskey
Authors: Cheyne Stanley A.
Published: April 2019

Kentucky is home to most of the bourbon whiskeys sold world wide. Sound speed measurements were made in a number of Kentucky bourbon whiskeys. Results of a variety of whiskeys, some having different alcohol content,s using a time-of-flight technique will be presented. In addition, phase speed measurements in impedance tubes using a transfer function technique will be presented. Experimental results will be compared to what is expected in a water/ethanol mixture.
Performance analysis of a looped travelling-wave thermoacoustic engine with phase-change
Authors: Yang Rui , Offner Avshalom , Meir Avishai , Ramon Guy Z.
Published: April 2019

Traditional thermoacoustic engines using conduction-driven, sensible heat transfer are unable to utilize low-grade thermal energy efficiently. Recently, it has been demonstrated that a phase-change thermoacoustic engine can initiate oscillations at a very low temperature difference; however, the steady-stage performance has yet to be extensively studied. In this work, a phase-change thermoacoustic engine with a looped resonator was simulated, based on a linear phase-change thermoacoustic theory. A binary gas mixture consisting of an inert gas and a condensable component was adopted as the working fluid. We numerically investigated the distributions of pressure, volumetric velocity, and acoustic power in the system. We also examined the steady-state performance (characterized by the pressure amplitude, acoustic power, and thermal efficiency) of the system under different mean pressures and temperature differences. The results show that the phase-change thermoacoustic engine can be driven by very low temperature differences (< 50 K) much more efficiently than its dry equivalent (i.e., the same system but without the condensable component). The findings demonstrate the promising potential of generating acoustic power through low-grade heat recovery, which can then be converted into electricity and cooling.
Effects of focus and tone on vowel space in Chongming Chinese
Authors: Yang Yike , Li Bei , Chen Si
Published: April 2019

The formant frequencies of vowels are prone to change according to contexts, but the effects of focus on vowel space are rarely studied. This study attempts to investigate how focus and tone may influence the vowel space in Chongming Chinese with a production experiment. Chongming Chinese is a Chinese dialect with a complex tonal system. Twelve syllables with the vowel /æ/ were chosen and the syllables spread over eight lexical tones (two level tones, four contour tones, and two checked tones). The target syllables were embedded in carrier sentences with different preceding and following syllables. Four focus conditions were manipulated: broad focus, initial focus, medial focus, and final focus. During the experiment, twelve participants were elicited with precursor questions to produce sentences with different focus locations. The frequencies of the first two formants (F1 and F2) were extracted over the middle 50 ms of the vowel interval for each target syllable. Formant tracks were calculated with the Burg algorithm in Praat. F1 and F2 values under each focus condition and tone will be compared. It is hypothesized that F1 and F2 will be increased under focus because focus might make the vowels more open and front.
Analyzing rhythmic convergence between two Swiss German dialects
Authors: Pellegrino Elisa , Dellwo Volker
Published: April 2019

With respect to existing evidence of rhythmic adjustments in response to the interlocutor’s idyosincratic characteristics, in the present study, we test whether interlocutors are likely to mutually adapt their rhythmic characteristics over the course of a conversation or after increased exposure to a dialogue partner. To study rhythmic accommodation, we used a corpus of read speech recorded by 18 speakers of two Swiss German dialects—Grison and Zurich German—before and after performing diapix tasks. The two dialects present crucial differences in the durational characteristics of intervocalic sonorants, vowel in open syllable and vowel in final position, thus creating different rhythm in these two dialects. To determine whether Grison and Zurich German speakers produce the rhythmic contrasts more similarly after the diapix tasks, we measured the Euclidean distance within a pair (ddpair) and within an individual (ddspeak) in three ratio measures devised to capture the durational differences between the two dialects. Preliminary results on ddpair have shown that certain durational contrasts are produced more similarly by certain pairs but more differently by other ones. Ratio measure related to the timing properties of vowels in final position does not change drastically before and after the interaction.
Variation in voice quality within speakers
Authors: Lee Yoonjeong , Kreiman Jody E.
Published: April 2019

Little is known about the nature or extent of everyday variability in voice quality within a speaker or how this differs across speakers. Using a suite of measures that map between acoustics and perception of voice quality, this study elucidates which acoustic variables within speakers’ individual voice spaces best characterize speakers. Based on studies of faces and cognitive models of speaker recognition, we hypothesized that a few measures would be important across speakers, but that much intra-speaker variability would be idiosyncratic. By using principal component analysis, we tested this hypothesis against a set of multiple sentence productions from 100 native speakers of English (fifty females and fifty males), recorded over three days. Acoustic variables measured every 5 ms on vowels and approximants corresponded to F0, vowel quality, spectral noise, source spectral shape, and variability. Across speakers the balance between higher harmonic amplitudes and inharmonic energy in the voice accounted for the most variance (females = 20%/males = 22%). Vowel quality and its variability accounted for an additional 12%/12% of variance. Remaining variance appeared largely idiosyncratic, suggesting that the speaker-specific voice space is different for different people. Notably, F0 did not emerge from these analyses. Implications for voice recognition are discussed. [Work supported by NIH/NSF.]
Applying refined automatic formant measurement to determination of the orientations of vowel distributions
Authors: Mielke Jeff , Thomas Erik R. , Fruehwald Josef , Stuart-Smith Jane , Sonderegger Morgan , Dodsworth Robin M. , McAuliffe Michael E
Published: April 2019

In order to remedy recurrent problems with false formant readings obtained with an automatic formant measurement routine, prototype-based automatic measurements were compared with manual formant measurements of the same uttered vowels. Two refinements that avoided false formants, one involving the option to skip measured formant racks and the other involving an expectation that successive formants would show successively lower amplitudes, were developed. This method was then applied to seven corpora representing diverse English dialects, with satisfactory results. The measurements of each vowel thus obtained were then subjected to principle component analysis to determine the orientation of the tokens in F1/F2 space. Most vowels exhibited distributions that apparently reflect degree of jaw opening. However, /u/ in North American varieties (with pre-/l/ and post-/j/ tokens excluded) showed mostly horizontal orientations, even when post-coronal and non-post-coronal tokens were considered separately. This pattern contrasted sharply with the vertical orientations of mid back vowels. /u/ was also the only vowel whose orientations coincided consistently with ongoing changes in the communities. We hypothesize that the factors responsible for the horizontal orientations of /u/ also lie behind its cross-linguistic tendency to shift frontward.
A comparison of four vowel overlap measures
Authors: Kelley Matthew C. , Tucker Benjamin V.
Published: April 2019

Measures of vowel overlap to explore the acoustic similarity between proposed and existing vowel categories. They typically compare F1 and F2, and sometimes duration. In the present study, we investigate four methods of quantifying vowel overlap: the spectral overlap assessment metric (Wassink, 2006), the a posteriori probability-based metric (Morrison, 2008), the vowel overlap assessment with convex hulls method (Haynes and Taylor, 2014), and the Pillai score as used by Hay et al. (2006). Based on the data for /i/ and /ɪ/ in the dataset of Hillenbrand et al. (1995), we used Monte Carlo style simulations and repeated subsampling to assess each method. We examined both the two-dimensional (F1 and F2) and three-dimensional (F1, F2, and duration) versions of the methods. We took the methods’ outputs as accurate if they produced values close to expected target values for each type of simulation, and we took the results as precise if there was little spread among the output values. The results suggest that the a posteriori probability-based metric is the most generally applicable, while the Pillai score should be used in scenarios where sensitivity to complete overlap is needed or where data cannot be said to be normally distributed.
Exceptional preservation of mid-Cretaceous marine arthropods and the evolution of novel forms via heterochrony
Authors: Luque J. , Feldmann R. M. , Vernygora O. , Schweitzer C. E. , Cameron C. B. , Kerr K. A. , Vega F. J. , Duque A. , Strange M. , Palmer A. R. , Jaramillo C.
Published: April 2019

A “beautiful chimera” from the mid-Cretaceous sheds light on the evolution of novel forms and forces a rethink of what a crab is.
Persistent Early to Middle Holocene tropical foraging in southwestern Amazonia
Authors: Capriles José M. , Lombardo Umberto , Maley Blaine , Zuna Carlos , Veit Heinz , Kennett Douglas J.
Published: April 2019

Archaeological research indicates that hunter-gatherers altered landscapes in southwestern Amazonia as early as 10,000 years ago.
Red Sea SAR11 and
Prochlorococcus
Single-Cell Genomes Reflect Globally Distributed Pangenomes
Authors: Thompson Luke R. , Haroon Mohamed F. , Shibl Ahmed A. , Cahill Matt J. , Ngugi David K. , Williams Gareth J. , Morton James T. , Knight Rob , Goodwin Kelly D. , Stingl Ulrich
Published: April 2019

Studies have shown that as we sequence seawater from a selected environment deeper and deeper, we approach finding every bacterial taxon known for the ocean as a whole. However, such studies have focused on taxonomic marker genes rather than on whole genomes, raising the possibility that the lack of endemism results from the method of investigation. We took a geographically isolated water body, the Red Sea, and sequenced single cells from it. We compared those single-cell genomes to available genomes from around the ocean and to ocean-spanning metagenomes. We showed that gene ortholog groups found in Red Sea genomes but not in other genomes are nevertheless common across global ocean metagenomes. These results suggest that Baas Becking’s hypothesis “everything is everywhere, but the environment selects” also applies to gene ortholog groups. This widely dispersed functional diversity may give oceanic microbial communities the functional capacity to respond rapidly to changing conditions.
Genome Sequence of a Facklamia hominis Isolate from a Patient with Urosepsis
Authors: Mostafa Heba H. , Taffner Samantha M. , Wang Jun , Malek Adel , Hardy Dwight J. , Pecora Nicole D.
Published: April 2019

The genome sequence of a
Facklamia hominis
strain isolated from the urine of a patient with acute cystitis and sepsis is reported. The genome contains
ermB
and
tet
(M) genes, consistent with the isolate’s phenotypic resistance to macrolides and tetracycline.
Draft Genome Sequence of a
bla
NDM-1
- and
bla
PME-1
-Harboring Pseudomonas aeruginosa Clinical Isolate from Pakistan
Authors: Irum Sidra , Potter Robert F. , Kamran Rubina , Mustafa Zeeshan , Wallace Meghan A. , Burnham Carey-Ann D. , Dantas Gautam , Andleeb Saadia
Published: April 2019

We performed Illumina whole-genome sequencing on a carbapenem-resistant
Pseudomonas aeruginosa
strain isolated from a cystic fibrosis patient with chronic airway colonization. The draft genome comprises 6,770,411 bp, including the carbapenemase
bla
NDM-1
and the extended-spectrum beta-lactamase
bla
PME-1
.
PO 8447 ROBUST CLINICAL TRIALS ARE NOT ENOUGH: OVERCOMING OPERATIONAL CHALLENGES FOR IMPLEMENTING REMSTART INTERVENTION PACKAGE (TRIP STUDY) INTO ROUTINE PRACTICE
Authors: Kivuyo Sokoine , Erick Frank , Loyse Angela , Jaffar Shabar , Mfinanga Godfrey S
Published: April 2019

Background

The REMSTART trial identified an effective package (cryptococcal antigen (CrAg) screening and enhanced antiretroviral therapy (ART) adherence support) that reduced all-cause mortality in advanced HIV (CD4 ≤200 cells/mm3) by 28% compared to standard of care. The introduction of this package at clinic level has been necessary to impact routine care practices in Tanzania.

Methods

The TRIP study is cluster-randomised. The intervention package was implemented in 16 routine care facilities (early arm) whilst 8 facilities continued with standard of care (deferred arm). At the end of 12 months follow-up, the intervention was implemented in the deferred facilities. The primary endpoint is all-cause mortality at 1 year.

Results

Implementation of the REMSTART intervention into routine care services has highlighted the following challenges: 1) Baseline CD4 testing: half (4/8) of rural facilities had no CD4 machines and in a further 3/8 there was a lack of reagents needed for CD4 testing. Clinical staging has replaced inclusion criterion where CD4 testing is not available; 2) Heavy staff workload in routine care; regular discussion with policymakers and workshops enhanced the take-up of the package; 3) Timing of ART: the Ministry of Health has updated national guidelines to include the package and delay ART by 2 weeks in CrAg-positives.

Conclusion

It has proven essential to engage with policymakers and programme managers from the outset, i.e. during the REMSTART trial itself and the following TRIP implementation study. The Ministry of Health has now changed the national HIV guidelines to include the REMSTART package and develop training modules for CrAg screening in all regional hospitals. The TRIP study has revealed key issues that must be addressed to allow scaling up the interventions.
PO 8471 A SURVEY OF CURRENT CLINICAL DATA MANAGEMENT PRACTICES IN SUB-SAHARAN AFRICA
Authors: Landuyt Hanne , Loen Harry Van , Dondeh Bai L , Gaye Badou M , Herrewege Yven Van
Published: April 2019

Background

Information on clinical data management (CDM) practices in clinical trials in sub-Saharan Africa is scarce. As part of ALERRT (the African coalition for Epidemic Research, Response and Training, an EDCTP-funded project) we want to gauge current CDM and ICT practices and identify possible gaps within different research institutions in sub-Saharan Africa. This information will be used to develop a scalable, GCP-compliant, robust CDM/ICT infrastructure suitable for resource-poor settings and response-ready in the event of an outbreak.

Methods

An online survey was designed to assess the experience of the participating sites with the various CDM processes, CDM documentation and facilities, the availability of dedicated staff and their experience with GCP. In addition, ICT features essential to CDM will be assessed. Lastly, information on the use of CDM software will be obtained. Respondents can request to receive personalised feedback (aimed to improve their CDM practices) based on their results. The survey, in English and French, will be sent out to 100 sites in sub-Saharan Africa. Sites with intermittent internet connections will receive an MS-Office Word-version of the survey.

Results

The survey will be closed after a month. Personalised feedback (if requested) will be sent to the respondents. Descriptive analysis of the survey results will be done, and results will be used to design standard data management tools, tailored to the needs of research sites in sub-Saharan Africa and suitable for emergency research. Both results and tools will be disseminated to the scientific community.

Conclusion

The results of this survey will provide relevant information on the current CDM and ICT practices in sub-Saharan Africa. Potential pitfalls will be identified and opportunities for improvement will be addressed. Furthermore, the survey will offer a chance to exchange ideas between African and European partners on how to implement good CDM and ICT practices.
PO 8480 TECHNICAL FEASIBILITY OF SENDING SMS TO REMIND TAKING MEDICATION AMONG PREGNANT AND BREASTFEEDING WOMEN LIVING WITH HIV IN KILIMANJARO, TANZANIA
Authors: Ngowi Kennedy M , Maro Eusibious , Nieuwkerk Pythia T , Aarnoutse Rob E , Mmbaga Blandina T , Marion Sumari-De Boer I
Published: April 2019

Background

Pregnant women living with HIV have difficulties in reaching adequate levels of adherence to treatment. One way to intervene is sending reminder cues using short message service (SMS) texts. We conducted a pilot study on the use of SMS among pregnant and breastfeeding women living with HIV in Kilimanjaro, Tanzania. One objective was to investigate technical feasibility of sending SMS reminders.

Methods

We enrolled adult (age 18–45) pregnant or breastfeeding women living with HIV from Kilimanjaro region, Tanzania. Women received a reminder SMS 30 min before usual time of intake. One hour after usual time of intake, they received an SMS asking whether she took medication. The women had to reply with ‘Yes’ or ‘No’. SMSes were sent less-than-daily and randomly distributed over the week. We did descriptive analyses of sent messages, delivered messages and estimation of adherence based on messages.

Results

We enrolled 25 women. In total, 4963 messages were sent of which 40 failed to be delivered (1%). 1664 SMS were sent with a question if medication was taken, wich received an answer 1580 times (91%). The answer was ‘Yes’ in 1137 cases (65%), ‘No’ in 10 cases (0.6%) and indefinable in 433 cases (26%). The median adherence based on ‘Yes’-answers was 74% [range 24–99]. If also counting the indefinable answers, the mean adherence was 100% [range 95–100].

Conclusion

Despite a few technical issues, we believe using SMS for reminder cues in Tanzania works well. The number of failed deliveries is nearly zero and women have replied to the majority of SMS. Efforts are needed to instruct women better on replying and on detecting the right answer in case of typing errors. We conclude that using SMS has potential to improve adherence and should be further investigated in clinical trials to determine the effect on adherence to treatment.
PO 8481 HIGH HEPATITIS B VIRUS INCIDENCE AMONG HIV-1-INFECTED TREATMENT-NAIVE ADULTS IN BOTSWANA
Authors: Phinius Bonolo B , Bokete Resego , Anderson Motswedi , Mbangiwa Tshepiso , Choga Wonderful , Moyo Sikhulile , Musonda Rosemary , Marlink Richard , Gaseitsiwe Simani
Published: April 2019

Background

Hepatitis B virus (HBV) is one of the leading causes of death worldwide despite a moderately potent vaccine. HBV prevalence has been shown to be higher in patients infected with the human immunodeficiency virus (HIV), hence increased liver-related morbidity and mortality, as well as general poor health outcomes in HIV-HBV co-infection. We estimated the HBV incidence among HIV-1-infected treatment-naïve adults in a longitudinal cohort in Botswana.

Methods

Plasma samples from 200 HIV-1C-infected treatment-naïve participants from a completed longitudinal cohort from 2004 to 2007 were screened for HBV surface antigen (HBsAg). HBsAg was assessed using Murex version 3 enzyme-linked immunosorbent assay as per manufacturer’s instructions at 4 timepoints, 12 months apart. We estimated HBV incidence with 95% confidence interval (CI). Cox proportional regression method was used to estimate hazard ratios [gender, age (≤35 or>35) years, CD4+T cell count (≤450 or>450) cells/µL and HIV viral load suppression (≤400 or>400) copies/mL].

Results

The median age of screened individuals was 32 years [Q1, Q3; 28, 40] and 83.5% [167/200] were female. Baseline median CD4+T cell count was 466.35 cells/µL [Q1, Q3: 380.43, 605.75] and median HIV viral load was 13 450 copies/mL [Q1, Q3: 2365, 37 400]. The HBV incidence was 3.6/100 person-years [95% CI: 2.2–5.6]. There were no significant differences by gender, age, HIV viral load suppression and CD4+T cell count.

Conclusion

We report for the first time a high HBV incidence among HIV-infected adults in Botswana. HBV incidence was high in this population despite generally high CD4 +T cell counts and lower HIV viral loads. Early screening of HBV in HIV-infected individuals is vital and should be included in the national HIV treatment guidelines.
PO 8504 EFFECT OF INCREASED USER FEES IN ACCESSING NEW TUBERCULOSIS DIAGNOSTIC SERVICES IN TANZANIA
Authors: Ngadaya Esther , Kimaro Godfather , Shemtandulo Ramadhani , Sandi Erica , Simsokwe Sunday , Nguma Oliva , Kibwana Omari , Mgina Nicholaus , Mfinanga Godfrey S
Published: April 2019

Background

While user fees in healthcare systems have been associated with quality improvement, a substantial increase may have a detrimental effect. This paper reports on the effects of increasing user fees on utilisation of TB diagnostic services in Tanzania.

Methods

We retrospectively analysed data on TB diagnostic services utilisation between July 2013 and June 2015 in Mnazi Mmoja Zanzibar (MMZ), Musoma and Sumbawanga hospitals. In July 2014, user fees in Musoma were increased substantially from 2 to 5 US dollar; Sumbawanga increased the fees stepwise, from 1 to 2 US dollar in July 2014, and from2 to 3 US dollar in January 2015 MMZ did not raise the fees. We compared TB services utilisation before and after introduction of user fees.

Results

Out of 7483 presumptive TB patients registered in all sites, 50.2% were males. Over half (3969) were registered before the user fee was increased. Among 3969, 1579 (39.8%) were from Musoma, 922 (23.2%) from Sumbawanga and 1468 (37.0%) from MMZ. Of the 3514 patients registered after the introduction of user fees, 983 (28%), 952 (27.1%) and 1579 (44.9%) patients were from Musoma, Sumbawanga and MMZ, respectively. The number of presumptive TB patients seeking TB diagnostic services at Musoma decreased significantly by 38% from 1579 to 983 after the increase of user fees (p=0.001). More females (817; 51.8% vs 458, 35.9%) attended Musoma before user fees were increased as compared to males whose attendance did not differ much (761; 48.2% vs 525; 53.4%); (p=0.01). There was no significant decrease of patients at Sumbawanga and MMZ.

Conclusion

There was a significant decrease in the number of presumptive TB patients who accessed new TB diagnostic services in Musoma after a substantial increase of user fees, the effect was stronger among women. Although user fees are beneficial, they should be increased stepwise so as not to affect service utilisation.
PO 8529 INTRODUCING A UNIQUE RESEARCH CAPACITY DEVELOPMENT PLATFORM SUPPORTING PREPAREDNESS FOR EFFECTIVELY COMBATING EPIDEMIC OUTBREAKS
Authors: Jamieson Nina , Lang Trudie
Published: April 2019

Background

In 2013, WHO stated that unless low-income countries become the generators, rather than the recipients, of health research data there will never be any real improvement in the devastating public health challenges these countries face. The Global Health Network was cited as an important agent for change in addressing this need.

The Global Health Network built an innovative digital platform, generating and supporting communities of practice focused on global health research. We have established a vast online knowledge-sharing resource, so far visited by more than 1.5 million frontline healthcare workers and researchers globally. Over 400,000 times online modules were taken by users from our target countries using our Training Centre, which offers a wide range of high-quality research skills courses. We also support skills development through regionally-led activities. Here we present how our approach is applied to support preparedness for epidemic outbreaks in Africa.

Methods

A community of practice was set up for the EDCTP2 ALERRT programme on The Global Health Network platform (https://alerrt.tghn.org/). It provides a mechanism for research staff to work together, share ideas, methods and approaches to foster knowledge exchange and collaboration. The ALERRT community of practice platform hosts training courses, help topics, templates, guidance – everything that is needed to run a good clinical study. The initial set of resources is available now, others are being developed following the knowledge gap analysis. In addition, our online platform offers free participation in the Professional Development Scheme – a unique framework to track research skills development.

Results

The ALERRT capacity development community of practice was launched in April 2018. We will present how this regionally-championed initiative is being taken up and what difference it is already making to the community of researchers.
PO 8536 BIOMEDICAL ETHICS AND REGULATORY CAPACITY BUILDING PARTNERSHIP FOR PORTUGUESE-SPEAKING AFRICAN COUNTRIES (BERC-LUSO)
Authors: do Céu Patrão Neves Maria , A Ribeiro Maria , S Carvalho Ana , Araújo Joana , Oliveira Martins Sofia , P Martins Ana , Mota Helder Filipe , Rhodes Baião Luís , Batista Jorge , Morais Afonso Joana De , Mangueira Katiza , D Reis Carla , Na Banga Cunhate , Sitoie Tânia
Published: April 2019

BERC-Luso is a project for building Ethics and Regulatory Capacity, to be developed in four sub-Saharan African countries: Angola, Guinea-Bissau, Mozambique and Cape Verde, and to be implemented in 2018–2021. National Ethics Committees (NECs) and National Regulatory Authorities (NRAs) have been engaged (6 institutions) with the partnership of 4 Portuguese institutions (experts in ethical review and regulatory supervision).

Considering that: 1) clinical trials are fundamental to improve healthcare and develop biomedical research; but 2) can only take place within regulatory systems and under ethical review protocols; and 3) some African countries still lack an adequate legislative framework and the expertise to assure good ethical review and regulatory supervision, it is urgent to change the current situation.

The BERC-Luso project will unfold at four different levels, each aiming at a specific goal in converging dynamics.

Legislative level: Presentation of a comparative study ofthe Portuguese Speaking African Partner Countries’ legislation on NECs and NRAs with recommendations for revision in compliance with the international requirements. The goal is to promote adequate internationally recognised legislation.

Educational level: Implementation of an intensive and comprehensive Education Programme, both theoretical and practical, reflexive and normative, ethical and legal, addressing the needs of the countries involved, within their cultural contexts, and in their own mother tongue. The goal is to promote capacity building.

Training level: Organisation of intensive internships, demanding participants to accurately apply everything they have learned to their everyday practice. The goal is to have knowledgeable and skilled experts.

Networking level: Build powerful digital tools to connect partner institutions, staff and participants during the project and beyond, creating a digital repository of documents, and different tools for ethical and regulatory evaluation.

These actions converge to provide internationally recognised legislation and expertise for the development of biomedical research for the benefit of the population.
PO 8538 STRENGTHENING SOCIAL STRATEGIES TO ENGAGE SUB-SAHARAN AFRICAN SOCIETIES TO VALUE CLINICAL RESEARCH: THE EXPERIENCE IN CONDUCTING CLINICAL TRIALS IN LAMBARéNé
Authors: C Angoissa Minsoko Pamela , T Agnandji Selidji
Published: April 2019

Background

Over the last two decades, clinical research activities have increased significantly in sub-Saharan Africa but societal engagement to make research socially and economically valuable is limited. Thus, engaging communities when designing clinical research and promoting social impacts of research are becoming key objectives among stakeholders involved in clinical research in sub-Saharan Africa. However, there is a need to define concepts and indicators to assess the strength of community engagement as well as the social impacts of clinical research.

Here, we hypothesised that the social meanings of willingness to participate and compliance to clinical trial procedures are relevant indicators to assess community engagement.

Methods

We conducted a retrospective, prospective case study of clinical trials conducted in CERMEL between 1995 and 2017. We performed a social meaning framework analysis of the following processes: protocol design, ethical and regulatory clearance, informed consent and medical study procedures. We identified the social meanings of each procedure according to the involvement of social components (actors, ideas, communication strategies).

Results

A total of 42 clinical trials were identified in the ClinicalTrials.gov and Pan-African Clinical Trials Registry databases and confirmed by the top management of CERMEL. Between 1995 and 2004, there was little social meaning connected to trial procedures. This period was associated with poor compliance to study procedures. Between 2005 and 2017, compliance to study procedures improved. Detailed results will be presented during the meeting.

Conclusion

The rise in willingness to participate in clinical research and improved compliance with study procedures were associated with the introduction of social components to medical procedures. Both indicators may be relevant to assess the strength of community engagement.
OC 8435 MULTI-BIOMARKER TEST STRIP FOR POINT-OF-CARE SCREENING FOR ACTIVE TUBERCULOSIS: A FIVE-COUNTRY MULTI-CENTRE TEST EVALUATION
Authors: Corstjens Paul , Hooij Anouk Van , Tjon Kon Fat Elisa , Herdigein Shannon , Namuganga Anna Ritah , Diergaardt Azaria , Mutavhatsindi Hygon , Gindeh Awa , Mihret Adane , Van De Spuy Gian , Gunther Gunar , Howe Rawleigh , Mayanja-Kizza Harriet , Sutherland Jayne , Chegou Novel N , Ottenhoff Tom , Walzl Gerhard , Geluk Annemieke
Published: April 2019

Background

Inexpensive rapid screening tests that can be used at the point-of-care (POC) are vital to combat tuberculosis. Particularly, less invasive non-sputum-based biomarker tests for all TB forms can help controlling transmission. Availability of such tests would significantly accelerate and streamline diagnostic approaches, improve cost-efficiency and decrease unnecessary costly GeneXpert referrals.

Methods

Multi-biomarker test (MBT) devices measuring levels of selections of up to six serum proteins simultaneously on a single lateral flow (LF) strip were produced. The strip contains individual capture lines for a biomarker selection allowing discrimination of TB-patients from other respiratory diseases (ORD). Only biomarkers successfully evaluated with singleplex strips (single biomarker tests) were applied to the MBT device. Quantitative signals are recorded with a low-cost handheld reader compatible with the applied luminescent up-converting particle (UCP) label. Biomarker selection and algorithms used to distinguish potential-TB and ORD are flexible.

Results

Results obtained with MBT strips containing multiple test lines correlate well with singleplex LF strips. Using LF tests for 5 selected biomarkers a sensitivity of 94% and specificity of 96% could be achieved with a confirmed South African selection of 20 TB and 31 non-TB samples. Patients were designated TB positive when scoring a value above the cut-off threshold for at least 3 out of 5 biomarkers. Serum samples of potential TB patients collected at five medical research institutes (Ethiopia, Namibia, South Africa, The Gambia, Uganda) were tested locally with MBT strips comprised of CRP, SAA, IP-10, Ferritin, ApoA-I and IL-6 and results analysed to obtain an overall pan-Africa applicable signature.

Conclusion

Evaluated POC applicable UCP-LF devices detecting serum biomarker signatures can help to distinguish active TB from other respiratory diseases and as such can prioritise highest-risk patients for further care. Ongoing prospective studies evaluate the MBT strip with fingerstick blood and do not require a laboratory or trained phlebotomist anymore.
PO 8569 INNOVATIVE DOMESTIC FINANCING FOR HEALTH RESEARCH & DEVELOPMENT IN THE EAST AFRICAN COMMUNITY
Authors: Ngirabega Jean De Dieu , Twungubumwe Novat , Pulakkal Nandan K , Bahati Prince N , Kamali Anatoli , Kibiki Gibson S
Published: April 2019

Background

Access to domestic financial resources is a pre-requisite for strengthening health research and development (R&D). Therefore, the East African Health Research Commission (EAHRC) commissioned a study to assess the financial needs of the East African Community (EAC) region and propose innovative domestic financing mechanisms for R and D in East Africa.

Methods

This study used a four-pronged approach as follows: a desk review of secondary data, followed by a survey to collect quantitative data from health R&D organisations and relevant ministries, followed by key informant interviews and, finally, a validation workshop. The study used 2014–2015 as the baseline year.

Results

Only 51 out of 160 organisations responded to the survey. Using triangulation of desk reviews, national budgets documents and reported organisational budgets, the annual investment in health R&D in the EAC is estimated at USD 301.71 million of which 86% is financed from external sources. The share of health R&D financing in the GDP and health budget stood at 0.21% and 1.27% respectively, while the share of domestic financing of health R&D to GDP was as low as 0.03%

The innovative domestic financing options suggested included: allocation of 10% of the USD 560 million of the sin-taxes collected; taxing 1% of the estimated USD 3 billion from inward remittances; fundraising for at least 2.5% of the USD 18.67 private sector investment in corporate social responsibility; issuing social impact bonds and the EAC Health Research Fund with an estimated annual performance of USD 20 million.

Conclusion

In order to sustain health R&D investments in EAC, the EAHRC proposes to develop a 10 year domestic financing roadmap using a strategic mix of tax- and non-tax-based innovations.
PO 8572 CAUSES OF HOSPITALISATION AND MORTALITY IN CHILDREN UNDER 5 YEARS OLD, NATIONAL HOSPITAL OF GUINEA-BISSAU, 2015–2017
Authors: Silva Isaquel B , Øland Christian B
Published: April 2019

Background

Studying the causes of hospitalisation is useful to understand the profile of illness and identify the most effective interventions. Guinea-Bissau was projected to reduce the under-5 mortality rate from 200 to 80/1000 live births (2005–2015); and the causes of the deaths were attributed: neonatal, pneumonia, malaria and diarrhea. In 2014 the mortality rate was 55/1000 live births in Guinea-Bissau, and malaria, diarrhea and respiratory infection were the main causes of illness. The present study aims to describe the main causes of hospitalisation and death in children under 5 years in the paediatric clinic of the ‘Simão Mendes’ National Hospital.

Method

Descriptive and retrospective study, with search of data from health care records. STATA and Microsoft Excel programmes were used for data analysis and cleaning. Cases defined as: children under 5 years of age, diagnosed from 2015 to 2017.

Results

In 17,250 cases of hospitalisation, the overall lethality rate for 2015–2017 was calculated at 7.5%. There was an increase in the lethality rate (10.8%) in 2017. Among the main causes of hospitalisation were gastrointestinal infection (26.9%), malaria (23%), respiratory infection (17.6%) and septicaemia (16.1%). Septicaemia is the disease with the highest lethality rate during these three years (18%), the case fatality rate due to gastrointestinal infection in 2017 (7.7%) was double compared with 2015 and 2016; 19% of deaths occured for those who lived far from hospital (>40 km).

Conclusion

2017 had fewer hospitalisation cases and is the year with the highest lethality rate. Gastrointestinal infection and malaria were the main causes of hospitalisation. The rate of lethality from diarrhoea and septicaemia has increased significantly and with worse outcome in those living far from Bissau.
OC 8450 ABSENCE OF MINORITY HIV-1 DRUG-RESISTANT VARIANTS FOLLOWING MOTHER-TO-CHILD TRANSMISSION DOES NOT PREDICT VIROLOGIC SUCCESS OF FIRST-LINE ANTIRETROVIRAL THERAPY
Authors: Kityo Cissy , Wit Tobias Rinke De , Nankya Immaculate , Balinda Sheilla , Sigaloff Kim , Ndashimye Emmanuel , Mugyenyi Peter , Quinones-Mateu Miguel
Published: April 2019

Background

Although minority HIV-1 drug-resistant HIV-1 variants may be selected under antiretroviral pressure, leading to therapy failure, their clinical significance remains controversial. This is particularly relevant in the case of prevention of mother-to-child transmission (MTCT), where transmitted drug resistance can affect treatment outcomes.

Methods

An ultrasensitive HIV-1 genotyping assay based on deep sequencing (DEEPGENHIV) with a 1% mutation frequency sensitivity, was used to quantify MTCT drug-resistant variants in 38 prenatally HIV-infected children experiencing (Group I, n=27) or not (Group II, n=11) virologic failure 12 months after initiating first-line antiretroviral therapy (ART) as part of a paediatric cohort in Uganda.

Results

Infants were infected with subtype A(n=20), D(n=16) or C(n=2) HIV-1 strains, distributed equally between both patients’ groups. Similarly, no significant difference was observed in intra-patient HIV-1 diversity among viruses obtained from Group I or II individuals at baseline. DEEPGENHIV was able to detect all the mutations originally detected in samples obtained from four control patients in Group II, where drug resistance was identified at baseline using Sanger sequencing, e.g. K65R (78% mutation frequency), K103N (47%), or M184V (85%). More importantly, a series of low abundance (<20% detection limit of Sanger) primary and compensatory mutations associated with resistance to PIs (D30N, Q48V), NRTIs (D67N, K219Q), or NNRTIs (L100I, K103N) were identified in both groups of patients, although just a few seem to have been selected and became majority variants after 12 or 24 months of ART.

Conclusion

DEEPGENHIV improves the detection of minority viral variants in infants following MTCT; however, most of the emergent HIV-1 drug resistance mutations were not present at low frequency at baseline in subjects failing ART, most likely being generated and selected following exposure to treatment. Further studies, using this or other ultrasensitive assays, are needed to better understand the transmission, dynamics and overall evolution of minority drug-resistant viruses in MTCT.
PO 8584 MULTIPLEXED MOLECULAR DETECTION OF MALARIA IN SIERRA LEONE
Authors: Ansumana Rashid , Lamin Joseph M , Lahai Joseph , Bangura Umaru
Published: April 2019

Background

Despite several control measures and policy changes in Africa, malaria remains one of the most prevalent diseases in West Africa. The gold standard for malaria diagnosis is microscopy. However, due to low technical capacities in resource-poor countries, rapid immunochromatographic tests are commonly used. In Sierra Leone,P. falciparum-specific ICT with histidine-rich proteins2(HRP-2) are used. HRP2 is specific toP. falciparumand the kit cannot be used to detect other species of malaria which are also present in the disease ecology in Sierra Leone.

Methods

In this study, we assessed 182 febrile subjects for malaria between April 2017-July 2018 at the Mercy Hospital Research Laboratory in Sierra Leone. The blood samples collected were assessed using the Walter Reed Army Institute for Research(WRAIR) multiplex malaria PCR kit packaged by BioGX, Inc. (Alabama, USA) for detecting and speciation of malaria from human blood. Thin and thick slides were done for each sample and the images recorded by a digital scope.

Results

Results show that, out of 163 samples run by multiplex PCR for malaria, 81 (49.7%) were positive forP. falciparum, while 82 (50.3%) were positive forPlasmodium vivax.

Conclusion

The presence ofP. vivaxin the disease ecology without any significant difference (p>0.05) withP. falciparumposes problems for clinical outcomes of febrile illnesses. Pan-malaria diagnostics in combination withP. falciparumcould avert under-diagnosis of malaria.
PO 8596 ENHANCING LABORATORY DIAGNOSIS OFMYCOBACTERIUM TUBERCULOSISIN SAMPLES FROM CHILDREN IN THE GAMBIA
Authors: Ayorinde Abigail , Coker Edward G , Mendy Alieu , Cole Fatoumatta , Sillah Abdou K , Mendy Francis S , Egere Uzochukwu , Kampmann Beate , Tientcheu Leopold D
Published: April 2019

Background

Routine laboratory diagnostic methods forM. Tuberculosiscomplex (MTBC) in induced sputum samples such as smear microscopy, GeneXpert and liquidMycobacteriagrowth indicator tube (MGIT) culture are often negative due to the paucibacillary nature of childhood tuberculosis. We hypothesise that prolonged incubation beyond routine culture time could potentially improve MTBC detection in specimens.

Methods

Out of over 1000 induced sputum samples collected during our childhood TB contact tracing research programme, we randomly selected 102 MTBC-negative MGIT cultures that had either been reported as contaminated (n=35) or negative (n=67) and further incubated these at 37°C for the duration of one month. Ziehl-Neelsen microscopy, MPT64 Antigen secretion and GeneXpert tests were repeated on all samples to detect MTBC. Bacterial DNA was extracted by CTAB method and genotyped using spoligotyping analysis.

Results

Of the 1160 routinely collected induced-sputum samples 12 (1%) were smear-positives; 41 (3.5%) Xpert-positives and 51 (4.4%) MGIT culture MTBC-positives. The remaining MGIT cultures were flagged as contaminated 393 (33.9%) or MTBC-negative 644 (55.5%). After prolonged incubation and retesting of the randomly selected ones, 26/102 (25.5%) were now microscopy-positive, 2/55 (3.63%) were GeneXpert-positive, 8/102 (7.8%) MPT64-Antigen-positive, and 38/102 (37.2%) had readable spoligotyping patterns. The predominant lineages were Mtb-Euro-American 16 (42.1%), Mtb-Indo-Oceanic 11 (28.9%) andM. africanumWest African type-2 8 (21%).

Conclusion

Prolonged incubation of routinely MTBC-negative induced-sputum cultures yielded positive results upon retest, highlighting the low sensitivity of routine diagnosis tools on pauci-bacillary paediatric samples. Spoligotyping was more sensitive to detect MTBC compared to GeneXpert. However, prolonged incubation will cause diagnostic delays and thus better strategies are needed to improve timely childhood TB diagnosis.