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Background: Resected rectal polyps with deep invasion into the submucosa (pT1b-sm2,3) or the muscle layer (pT2) are currently confronted with surgery due to non-curative resection. Aims: We evaluated the efficacy, safety, and locoregional control of adjuvant radiotherapy (RT) and/or chemotherapy (CT) following endoscopic KAR (knife-assisted resection) in patients with invasive early rectal cancers who are unwilling or unsuitable for additional surgical resection. Methods: Fifty-one patients with early rectal cancers, pT1b or pT2, underwent post-resection adjuvant RT and/or CT in 15 centers worldwide. "En bloc" macroscopic resection, R0 resection, recurrence rate, and adverse events following resection and adjuvant therapy were recorded in a multicenter retrospective cohort study. Results: Diagnostic staging (38/51, 75%) was the main reason for ELE. Macroscopic "en bloc" resection was demonstrated in 50/51 (98%), with an average follow-up of 20.6 months. Endoscopic recurrence occurred in 7/51 (13.7%) of patients, with mean time for diagnosis of recurrence at 8.9 months. Adjuvant therapy consisted of RT in 49.0% (25/51), CT in 11.8% (6/51), and combined CRT in 39.2% (20/51) of the cases. Perforation, severe post-procedural bleeding, and incontinence were the most frequent complications. The absence of superficial ulceration was associated with macroscopic complete resection, while the lesions with lower budding stage, clear lateral margins, lesion size < 40 mm, and needle-type knife used were associated with less endoscopic recurrencies. Conclusions: Our data investigated adjuvant RT and/or CT after endoscopic KAR of infiltrative rectal cancers (pT1bsm2,3-pT2) as being safe and effective for locoregional control and providing a non-surgical treatment option for patients with a non-curative resection. [ABSTRACT FROM AUTHOR]

Electric impulse drilling (EID) technology has great industrialization potential since it has unique advantages in crushing hard rocks of deep formation. To study the mechanism of dielectric breakdown is of great significance for accelerating the practical application of EID technology. In this paper, the dielectric breakdown damage model (DBDM) is established based on the heterogeneous granite model. On the basis of DBDM, the whole process of absolute dielectric breakdown (ADB) is studied, including the formation of the plasma channel and the variation of the electric field. Then, the mechanism of regional dielectric breakdown (RDB) development to ADB is studied, and the influence of peak voltage, electrode spacing and the parameters of a high-voltage electric pulse (HVEP) is discussed. Besides, the efficiency of two dielectric breakdown modes is evaluated. It is found that dielectric breakdown will only occur in the domain where the strength of the local electric field formed by HVEP exceeds the critical breakdown field strength of rock. RDB will occur when the pulse duration is too short or the peak voltage is too low. It is worth noting that RDB can be developed into ADB under multi-HVEPs. Moreover, under the same voltage, there is almost no difference between the failure volume caused by RDB under multi-HVEPs and ADB under a single HVEP. However, the energy consumption of the RDB under multi-HVEPs decreases exponentially with increasing voltage and is always higher than that of the ADB under a single HVEP. When designing the supporting tools and bits of EID technology, the life of insulation, the characteristics of formation, and energy utilization should be fully considered. The related research in this paper aims to provide reference and guidance for the application of EID technology in drilling engineering. Highlights: The variation of the electric field, the change of minerals and the generation of plasma channel in granite during dielectric breakdown is studied. The effect of the characteristics of high-voltage electric pulse (HVEP) on the dielectric breakdown in granite is studied. The mechanism and rock-breaking efficiency of absolute dielectric breakdown (ADB) and regional dielectric breakdown (RDB) are explored. [ABSTRACT FROM AUTHOR]

This research states that there is a process of involvement of colonial debt in Java, Indonesia in the typical economic characteristics of the loan and repayment cycle in the pawnshop system which is related to Eid al-Fitr, the Javanese months, and the climate of the planting season. This characteristic becomes an interesting study and very valuable knowledge for the development of socio-economic history in the area studied. The ability to understand the socio-economic conditions of society needs to be carried out in line with government programs to alleviate poverty. Therefore, understanding this article will help the government and society in choosing alternative solutions to their economic problems. This study focuses on the relationship between the lending cycle during Eid and the tendency to borrow during the planting climate. This research uses qualitative historical research methods. The practice of providing credit services using the pawnshop model was carried out based on the rules set by the colonial government. The process of borrowing and repaying loan funds is explained with the power of various analytical approaches. This problem will be explained using historical studies and other social sciences to enrich the explanation.

Information technologies and the entirely new digital world are experiencing significant development in the second and third decades of the twenty-first century. This development has led to the need to realize the concept of legal regulation of cyberspace, especially in the segment of digital identification. Digital identification is necessary to ensure security as well as the protection of personal data. Additionally, digital identification must guarantee the reliability and trust of signatories in the technologies used. The regulations adopted in previous years implied the existence of a PKI infrastructure and the storage of the private key by the signatory. However, the development of technologies and the widespread use of mobile and smart devices have generated the need for remote signing, cloud-based signing, and the creation of digital wallet techniques. It is precisely in this segment that the regulations have been amended. The paper presents EU regulations in this area and the situation in Bosnia and Herzegovina. It is particularly emphasized that the use of reliable legally grounded digital identification has not yet begun to be implemented in Bosnia and Herzegovina, and that it is necessary to establish practices and systems based on legal regulations that are aligned with the EU, as well as with the legal framework in Bosnia and Herzegovina. [ABSTRACT FROM AUTHOR]

This study explores the trend of Eid-related video advertisements in Malaysia on online streaming platforms like YouTube, as focusing on major corporate channels such as Petronas, TNB, Malaysia Airlines, and Telekom Malaysia. Thus, the aim of the study is to explore the trend of Eid advertisements and Malaysian audience engagement through corporate video on YouTube Channel. Notable differences emerged in how each company portrayed these values, showcasing unique approaches to brand representation. Despite the commonality in values, the varied portrayal methods indicated distinct brand identities for each organisation. The analysis was conducted using content analysis through viewing the Eid advertising video which emphasised the importance of crafting a brand image within the Eid-themed video content to resonate and be memorable among viewers. Findings shows that while companies align on shared values for Eid advertisements, the way these values are communicated plays a crucial role in shaping the brand's image and audience engagement. Consistent and respectful representation of shared values building trust towards the audiences. Meanwhile, broadcasters must ensure that the advertisements they air are culturally sensitive and align with the values of the audience. [ABSTRACT FROM AUTHOR]

This review aims to highlight the occurrences of several emerging and re-emerging infectious diseases, particularly 13 types under surveillance of Indonesia’s emerging contagious disease task force. These diseases are considered potentially epidemic, due to the nature of tropical climate and high humidity of Indonesia’s area. Several factors contribute to the emergence of these diseases: in conjunction with human behavior. Most of these diseases are zoonotic, specifically spread by viruses. The latest emerging infectious disease in Indonesia is monkeypox. Controlling the management of EID-REIDs presents a major obstacle for international health initiatives, particularly in Indonesia because of its extensive population, varied geographical landscape, and constrained resources. Overcoming these obstacles demands tactics like prioritizing Indonesian policies, bolstering disease monitoring systems, upgrading diagnostic capacities, fortifying public health facilities, fostering community involvement and education, and executing efficient prevention and management protocols. These strategies should be implemented in collaboration with international partners and organizations to effectively control and prevent the spread of emerging and re-emerging infectious diseases in Indonesia.

Ophidiomyces ophidiicola (Oo) is a fungal pathogen and the causative agent of ophidiomycosis that has affected multiple snake taxa across the United States, Europe, and Asia. Ophidiomycosis has often been referred to as an emerging infectious disease (EID); however, its status as an EID has recently come under debate. Oo infections have been confirmed in wild snake populations in Texas; however, it is unknown if the pathogen is novel (i.e., invasive) or endemic to the state. To address this knowledge gap, we conducted surveys for Oo among preserved Nerodia deposited at three university museums in Texas. First, we visually assessed snakes for signs of infection (SOI), and if SOI were present, we sampled the affected area. We then used quantitative polymerase chain reaction to diagnose the presence of Oo DNA on areas with SOI and used these data to evaluate spatiotemporal patterns of Oo prevalence. We also tested for significant spatial clusters of Oo infenction using a Bernoulli probability model as implemented in the program SatScan. We found that the proportion of snakes exhibiting SOI was constant over time while the prevalence of Oo DNA among those SOI increased across space and time. Within these data, we detected an incidence pattern consistent with an introduction and then spread. We detected six spatial clusters of Oo infection, although only one was significant. Our results support the hypothesis that Oo is an emerging, novel pathogen to Texas snakes. These data narrow the knowledge gap regarding the history of Oo infections in Texas and establish a historical record of confirmed Oo detections in several counties across the state. Thus, our results will guide future research to those areas with evidence of past Oo infections but lacking confirmation in contemporary hosts. There is a considerable knowledge gap regarding the spatiotemporal dynamics of Ophidiomyces ophidiicola (Oo) infection among Texas snakes. To address this knowledge gap, we conducted surveys for signs of Oo infection (SOI) among preserved Nerodia deposited at three university museums in Texas. We used quantitative polymerase chain reaction to diagnose the presence of Oo DNA on snakes with SOI and then used spatiotemporal patterns in these data to evaluate the plausibility of novelty or endemism for Oo in this part of North America. [ABSTRACT FROM AUTHOR]

The transition to eGovernment creates challenges in terms of the confidentiality and security of sensitive data of citizens and organizations. Information systems require the implementation of appropriate security mechanisms to ensure the confidentiality, integrity and availability of data. Blockchain technology has the potential to transform public services, enabling administrations to organize processes and manipulate information in an innovative way. Blockchain’s high level of security is an advantage over other tools and technologies used in data processing. This study examines how blockchain technology can contribute to the development of the new generation of eGovernment services and proposes an ecosystem model based on SSI (Self-Sovereign Identity) authentication and Smart Contracts between citizens and administrations. The results can be a starting point for the development of national initiatives to use the blockchain as a platform for communications and transactions in the public sector. Blockchain based electronic services provide enhanced security for governments, citizens and businesses.

Introduction: Early infant diagnosis among human immunodeficiency virus (HIV)-exposed infants is a critical component of the prevention of mother-to-child transmission programs. The Kenya Ministry of Health recently revised their early infant diagnosis (EID) guidelines to include HIV DNA PCR testing at birth (pilot only), six weeks, six months, and 12 months postnatal and a final 18-month antibody test, to be in line with World Health guidelines on Management of HIV and treatment for infants. Despite these interventions to address barriers to IED, Kenya faces challenges in the uptake of EID. This study explored perceptions of caregivers and mothers of HIV positive infants in order to make recommendations to strengthen the provision of EID services in Kenya. Methods: We sought to understand the determinants of caregivers and or mothers of HIV positive infants seeking early infant Diagnosis services and treatment in six public health facilities located in six counties of Kenya. We conducted ten focus group discussions with mothers and caretakers of infants seeking Early Infant Diagnosis services and treatment in level four and level five public health facilities in six counties with high, medium, and low prevalence of HIV in Kenya. All Focus Group Discussions were audiotaped, transcribed, translated, and coded for analysis. Findings: Most respondents reported knowledge and awareness of EID services. However, respondents in rural counties reported less knowledge and awareness of EID compared to those from urban counties. Negative provider attitudes complicated respondents' pathway to seeking care in a stigma-free environment. Linkage by Community Health Volunteers to caregivers and mothers of an infant was noted as a critical component to care. While most respondents were satisfied with how they were treated by health providers while seeking services, most respondents complained about delays and long waiting times to receive services. At the community level, intimate partner violence is a key barrier to caretakers and mothers in seeking EID care. Conclusion & Recommendations: Mothers and caregivers of infants had higher levels of awareness (knowledge and understanding) of EID. Interventions to ensure that caregivers and mothers of infants are not stigmatized as well as addressing delays and long waiting times for the provision of services should be implemented while ensuring interventions to assist mothers and caregivers to address and cope with intimate partner violence initiated at facility and community level. [ABSTRACT FROM AUTHOR]

The current study intended to analyze the levels of joy in religious festivals. It involved 387 Pakistani Muslims including men (n=143) and women (n=282). Data was collected through a specifically developed questionnaire in Urdu. The findings revealed that Pakistani Muslims enjoy their festivals at a very low degree and the levels of joy in Eid-ul-Fitr and Eid-ul-Adha remains significantly lower than the levels of joy in weddings. The level of joy for Pakistanis during different festivals could not exceed 31 percent. The findings further revealed that, instead of being joyous, a little minority of the respondents felt sadness and tiredness while celebrating different festivals. Men had significantly higher levels of joy on Eid-Ul-Fitr and Eid-Ul-Adha as compared to women. Women had significantly higher levels of joy on close-relative’s wedding as compared to men. Unmarried had significantly higher levels of joy on friend’s wedding as compared to married. Kajian kali ini bertujuan untuk menganalisis tingkat keceriaan pada hari raya keagamaan. Ini melibatkan 387 Muslim Pakistan termasuk pria (n=143) dan wanita (n=282). Data dikumpulkan melalui kuesioner yang dikembangkan secara khusus dalam bahasa Urdu. Temuan mengungkapkan bahwa Muslim Pakistan menikmati festival mereka pada tingkat yang sangat rendah dan tingkat kegembiraan di Idul Fitri dan Idul Adha tetap jauh lebih rendah daripada tingkat kegembiraan dalam pernikahan. Tingkat kegembiraan orang Pakistan selama festival yang berbeda tidak bisa melebihi 31 persen. Temuan lebih lanjut mengungkapkan bahwa, alih-alih gembira, sebagian kecil responden merasakan kesedihan dan kelelahan saat merayakan festival yang berbeda. Pria memiliki tingkat kegembiraan yang jauh lebih tinggi pada Idul Fitri dan Idul Adha dibandingkan dengan wanita. Wanita memiliki tingkat kegembiraan yang jauh lebih tinggi pada pernikahan kerabat dekat dibandingkan dengan pria. Belum menikah memiliki tingkat kegembiraan yang jauh lebih tinggi pada pernikahan teman dibandingkan dengan menikah.

National digital identity management systems have gained traction as a critical tool for inclusion of citizens in the increasingly digitised public services. With the help of the World Bank, countries around the world are committing to building and promoting digital identification systems to improve development outcomes as part of the Identity for development initiative (ID4D). One of those countries is Nigeria, which is building a national ID management database for its over 100 million residents. However, there are privacy, security, human rights, ethics and socio-cultural implications associated with the design and scaling of such a system at a national level. Through a mixed method approach, this paper identifies some of these concerns and categorises which ones Nigerians are most worried about. It provides an empirically sound perspective around centralised national electronic identity (eID) management system, public trust and responsible data governance, and offers recommendations on enhancing privacy, security and trustworthiness of the digital infrastructure for identity management in Nigeria.

The Asian elephant (Elephas maximus), also known as Asiatic elephant is facing a significant decline in its wild populations due to habitat loss, fragmentation and degradation, leading to increased conflicts between humans and elephants. Preserving this iconic species is crucial, prompting researchers to explore various aspects of its biology, behavior, ecology and conservation efforts. In light of the profound importance of this subject, this study utilizes a descriptive systematic literature review (SLR) to examine global research trends on Asian elephants. Analyzing a dataset of 1780 articles spanning from 1914 to 2022, the study reveals a notable increase in publications, particularly since 2000, with 142 articles published in 2022 alone. This research provides a comprehensive overview of advancements in Asian elephant studies, promoting international collaboration and knowledge exchange among researchers. While research from leading scientific countries can aid in conservation efforts, there is a call for more inclusive, participatory and fair approaches. The study demonstrates a commitment to Equity, Inclusion and Diversity (EID) by adopting a multifaceted approach that considers the needs, perspectives and contributions of diverse stakeholders. By addressing disparities and advocating for social justice within elephant conservation, the study emphasizes the urgent need for collective action in conservation, welfare improvement, conflict resolution, ecosystem balance and overall enhancement of understanding about Asian elephants. Serving as a valuable resource for policymakers, conservation organizations and researchers, the study not only synthesizes existing literature but also identifies research gaps, highlights areas requiring immediate attention, and offers collaborative opportunities for global scientists to contribute to the well-being and preservation of this majestic species. [ABSTRACT FROM AUTHOR]

An extrinsic electron induced by a dielectric (EID) AlGaN/GaN MOS high-electron-mobility transistor (HEMT) on Si substrate was designed and investigated. The EID structure with SiO2 deposition and subsequent high-temperature annealing, which induces two-dimensional electron gases (2DEGs) on fully depleted AlGaN/GaN hetero-epitaxial layers with thin AlGaN barrier layer, was applied to access and drift regions in the HEMT. The fabricated HEMT exhibited enhancement-mode operation with a specific on-resistance of 7.6 mΩ cm2 and a breakdown voltage of over 1 kV. In addition, electron state analysis using hard X-ray photoelectron spectroscopy revealed that changes in the chemical states of Al and energy level lowering at the SiO2/AlGaN interface affect the induction of 2DEG in the EID structure. The proposed HEMTs should become a strong candidate for highly reliable high-power switching devices due to the damage-less fabrication without dry etching or fluorine plasma exposure processes on the semiconductor layers. [ABSTRACT FROM AUTHOR]

Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa. Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing. Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43 346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017–2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns. Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing. Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged.

Background: Human immunodeficiency virus (HIV) infection in pregnant women has an important role in its spread to the pediatric population through vertical transmission. Effective utilization of Prevention of Parent to Child Transmission (PPTCT) services can reduce this spread. This study aims to determine the vertical transmission of HIV, the seroprevalence of HIV in antenatal women, demographic factors of seropositive women, and utilization of PPTCT services to minimize the risk of mother-to-child transmission. Methods: This study was conducted to assess vertical transmission of HIV in the newborn of HIV pregnant women attending antenatal clinic (ANC) of a tertiary care hospital from August 2014 to December 2020. Pretest counseling, HIV testing, and posttest counseling were done as per National AIDS Control Organization (NACO) guidelines. Antiretroviral prophylaxis was given to seropositive women and their children. Analysis of demographic data of seropositive women and assessment of the utilization of PPTCT services were done according to available records. Results: In the study time, 139,619 new antenatal registrations were there, 68.21% of women attended pretest counseling and of them, 95.28% gave consent for HIV testing. Out of which, 0.14% were reported as HIV seropositive in PPTCT (tested according to NACO guidelines). In the study time, a total of 188 HIV-positive deliveries were conducted in our institute. Out of which, 144 (76.6%) were ANC-booked patients and 44 (23.4%) were unbooked patients and directly came in labor, deliveries were conducted according to NACO guidelines and all newborns were given nevirapine syrup. All newborns were followed up until 18 months and in study time, 78 dry blood samples (DBSs) were sent for DNA polymerase chain reaction (PCR) detection and all were reported negative by the reference laboratory at AIIMS, New Delhi. Conclusions: Adherence to testing, treatment, and follow-up in the antenatal and postnatal period can minimize the risk of HIV transmission from mother to child.

Background : Gastro-bronchial and gastro-colic fistulas (GB-GC) represent a rare, but serious complication after laparoscopic sleeve gastrectomy (LSG). The aim of this study is to evaluate the efficacy of endoscopic first-line approach with endoscopic internal drainage (EID) by inserting double pigtail stents (DPS) Methods: We retrospectively analyzed data from 40 consecutive patients referred at two tertiary centers for gastro-bronchial (N=30) and gastrocolic (N=10) fistulas following LSG. Nineteen patients previously experienced emergency surgical drainage. The mean interval between the index surgery and endoscopic fistula treatment was 265.6±521 days. Results: Healing of the fistulous tract was achieved in 19 patients (47.5%), with complete resolution at an average follow-up of 16 months. Mean time of treatment duration was 157.8±141 days with 5.0±2.9 endoscopic sessions. No major adverse events were registered. Conclusions: Despite complete fistula healing was achieved in less than 50% of our population, EID for GB/GC fistula after LSG still represents the most conservative approach with low complications rate. Previous surgical drainage seems to be a positive prognostic factor for endoscopic healing. While the longer the interval between the index surgery and endoscopic treatment, the lower was the rate of treatment success. [ABSTRACT FROM AUTHOR]

Abstract Background Early infant diagnosis (EID) of HIV-exposed and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor. Methods The research was conducted in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of clinic waiting times, and 3) patient and health worker focus groups. Results HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV-positive infants were LTFU and did not initiate ART. Conclusions Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in EID turn-around times for PCR results, and initiation of ART by nurses in child-at-risk services. Trial registration Retrospectively registered, ISRCTN67747315 , July 24, 2019.

Background: Early diagnosis and confirmation of HIV infection in newborns is crucial for expedited initiation of antiretroviral therapy. Confirmatory testing must be done for all children with a reactive HIV PCR result. There is no comprehensive data on confirmatory testing and HIV PCR test request rejections at National Health Laboratory Service laboratories in South Africa. Objective: This study assessed the metrics of routine infant HIV PCR testing at the Tygerberg Hospital Virology Laboratory, Cape Town, Western Cape, South Africa, including the proportion of rejected test requests, turn-around time (TAT), and rate of confirmatory testing. Methods: We retrospectively reviewed laboratory-based data on all HIV PCR tests performed on children ≤ 24 months old (n = 43 346) and data on rejected HIV PCR requests (n = 1479) at the Tygerberg virology laboratory over two years (2017–2019). Data from sample collection to release of results were analysed to assess the TAT and follow-up patterns. Results: The proportion of rejected HIV PCR requests was 3.3%; 83.9% of these were rejected for various pre-analytical reasons. Most of the test results (89.2%) met the required 96-h TAT. Of the reactive initial test results, 53.5% had a follow-up sample tested, of which 93.1% were positive. Of the initial indeterminate results, 74.7% were negative on follow-up testing. Conclusion: A high proportion of HIV PCR requests were rejected for pre-analytical reasons. The high number of initial reactive tests without evidence of follow-up suggests that a shorter TAT is required to allow confirmatory testing before children are discharged. [ABSTRACT FROM AUTHOR]

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Background: Understanding the missed opportunities in early infant HIV testing within the PMTCT program is essential to address any gaps. The study set out to describe the clinical and sociodemographic characteristics of the infants presenting late for early infant diagnosis in Kenya. Methods: We abstracted routinely collected clinical and sociodemographic characteristics, in a cross-sectional study, on all HIV-infected infants with a positive polymerase chain reaction (PCR) test from 1,346 President’s Emergency Plan for AIDS Relief (PEPFAR) supported health facilities for the period October 2016 to September 2018. We used multivariate logistic regression to examine the association of sociodemographic and clinical characteristics with late (>2 months after birth) presentation for infant HIV testing. Results: Of the 4,011 HIV-infected infants identified, the median infant age at HIV diagnosis was 3 months [interquartile range (IQR), 1-16 months], and two-thirds [2,669 (66.5%)] presented late for infant HIV testing. Factors that were associated with late presentation for infant testing were: maternal ANC non-attendance, adjusted odds ratio (aOR) 1.41 (95% confidence interval (CI) 1.18 -1.69); new maternal HIV diagnosis, aOR 1.45, (95%CI 1.24 -1.7); and lack of maternal antiretroviral therapy(ART), aOR 1.94, (95% CI 1.64 - 2.30). There was a high likelihood of identifying HIV-infected infants among infants who presented for medical services in the outpatient setting (aOR 18.9; 95% CI 10.2 - 34.9) and inpatient setting (aOR 12.2; 95% CI 6.23-23.9) compared to the infants who presented late in maternity. Conclusion and Global Health Implications: Gaps in early infant HIV testing suggest the need to increase maternal pre-pregnancy HIV diagnosis, timely antenatal care, early infant diagnosis services, early identification of mothers who seroconvert during pregnancy or breastfeeding and improved HIV screening in outpatient and inpatient settings. Early referral from the community and access to health facilities should be strengthened by the implementation of national PMTCT guidelines. Copyright © 2021 Langat et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

This paper outlines a proposal for how to implement Central Bank Digital Currencies (CBDC) based on open banking standards and supports both account-based and token-based CBDC models, transacting online and offline with immediate finality, while recognising the European PSD2 requirements, including (multi-factor) strong customer authentication (SCA). The authors recognise the limitations with current smartphone technologies with respect to deploying trusted applications and in performing the role of a qualified signature creation device - highly relevant to offline scenarios. In some cases, the authors recommend regulatory review, in others they recommend taking full advantage of the existing capabilities of the separated secure execution environment by dividing the control of a CBDC transaction between both payee and payer devices, so that if one device was compromised, this does not undermine the whole transaction. It balances the need for anonymity with financial crime regulatory requirements and suggests that a CBDC wallet can be enriched with eID capabilities, or vice versa. The wallet is bound to the person's identity, their device and software via a chain of trust (eIDAS for the EU or similar for non-EU countries). The authors combine this with self-sovereign identity (SSI) principles to maximize privacy and minimize information sharing with a third party [ABSTRACT FROM AUTHOR]

Background: Human immunodeficiency virus (HIV) infection in pregnant women has an important role in its spread to the pediatric population through vertical transmission. Effective utilization of Prevention of Parent to Child Transmission (PPTCT) services can reduce this spread. This study aims to determine the vertical transmission of HIV, the seroprevalence of HIV in antenatal women, demographic factors of seropositive women, and utilization of PPTCT services to minimize the risk of mother-to-child transmission. Methods: This study was conducted to assess vertical transmission of HIV in the newborn of HIV pregnant women attending antenatal clinic (ANC) of a tertiary care hospital from August 2014 to December 2020. Pretest counseling, HIV testing, and posttest counseling were done as per National AIDS Control Organization (NACO) guidelines. Antiretroviral prophylaxis was given to seropositive women and their children. Analysis of demographic data of seropositive women and assessment of the utilization of PPTCT services were done according to available records. Results: In the study time, 139,619 new antenatal registrations were there, 68.21% of women attended pretest counseling and of them, 95.28% gave consent for HIV testing. Out of which, 0.14% were reported as HIV seropositive in PPTCT (tested according to NACO guidelines). In the study time, a total of 188 HIV-positive deliveries were conducted in our institute. Out of which, 144 (76.6%) were ANC-booked patients and 44 (23.4%) were unbooked patients and directly came in labor, deliveries were conducted according to NACO guidelines and all newborns were given nevirapine syrup. All newborns were followed up until 18 months and in study time, 78 dry blood samples (DBSs) were sent for DNA polymerase chain reaction (PCR) detection and all were reported negative by the reference laboratory at AIIMS, New Delhi. Conclusions: Adherence to testing, treatment, and follow-up in the antenatal and postnatal period can minimize the risk of HIV transmission from mother to child. [ABSTRACT FROM AUTHOR]

Few studies have explored the relationship between early infant diagnosis (EID) of HIV and mothers' engagement in care under Option B+. We conducted in-depth interviews with 20 women who initiated antiretroviral therapy (ART) under Option B+ in rural South Africa to explore the interactions between EID and maternal care engagement. Drawing on practice theory, we identified themes relating to Option B+ care engagement and EID. Women's practice of engagement with HIV care shaped their decision-making around EID. Mothers who disengaged from care during pregnancy were less inclined to utilise EID as they lacked information about its availability and benefits. For some mothers, tensions between wanting to breastfeed and perceptions that it could facilitate transmission led to repeated utilisation of EID as reassurance that the child remained negative. Some mothers used their child's negative result as a proxy for their status, subsequently disengaging from care. For some participants, an HIV diagnosis of their infant and the subsequent double burden of treatment visits for themselves and their infant, contributed to their disengagement. Women's care-seeking practices for themselves and their infants work in a symbiotic ecosystem and should be viewed interdependently to tailor interventions to improve EID uptake and Option B+ care engagement. [ABSTRACT FROM AUTHOR]

This review aims to highlight the occurrences of several emerging and re-emerging infectious diseases, particularly 13 types under surveillance of Indonesia's emerging contagious disease task force. These diseases are considered potentially epidemic, due to the nature of tropical climate and high humidity of Indonesia's area. Several factors contribute to the emergence of these diseases: in conjunction with human behavior. Most of these diseases are zoonotic, specifically spread by viruses. The latest emerging infectious disease in Indonesia is monkeypox. Controlling the management of EID-REIDs presents a major obstacle for international health initiatives, particularly in Indonesia because of its extensive population, varied geographical landscape, and constrained resources. Overcoming these obstacles demands tactics like prioritizing Indonesian policies, bolstering disease monitoring systems, upgrading diagnostic capacities, fortifying public health facilities, fostering community involvement and education, and executing efficient prevention and management protocols. These strategies should be implemented in collaboration with international partners and organizations to effectively control and prevent the spread of emerging and re-emerging infectious diseases in Indonesia.

Since 2015, the Research Institute of Organic Treasures (R.I.O.T.) has combined fermentation practices and social experimentation in Hong Kong to give biological byproducts from human and urban metabolisms a regenerative purpose. Here putrescible wastes emitted from our kitchens, toilets, and bodies are considered our most foundational design material that contributes to a “world of eaters” (DuPuis 2015). In this applied design work, the concept of upcycling is socio-materially extended into shared forms of upskilling, and therefore referred to as upcrafting. In an effort to combine practical outcomes with long-term welfare creation, R.I.O.T. brings together laypersons, natural scientists, and artists, into open-ended explorations of alternative knowledge and change making, or what Melanie DuPuis calls “extended peer communities” (ibid. 155).

Abstract Background Universal antiretroviral therapy (ART) for all pregnant/ breastfeeding women living with Human Immunodeficiency Virus (HIV), known as Prevention of mother-to child transmission of HIV (PMTCT) Option B+ (PMTCTB+), is being scaled up in most countries in Sub-Saharan Africa. In the transition to PMTCTB+, many countries face challenges with proper implementation of the HIV care cascade. We aimed to describe the feasibility of a PMTCTB+ approach in the public health sector in Swaziland. Methods Lifelong ART was offered to a cohort of HIV+ pregnant women aged ≥16 years at the first antenatal care (ANC1) visit in 9 public sector facilities, between 01/2013 and 06/2014. The study enrolment period was divided into 3 phases (early: 01–06/2013, mid: 07–12/2013 and late: 01–06/2014) to account for temporal trends. Kaplan-Meier estimates and Cox proportional-hazards regression models were applied for ART initiation and attrition analyses. Results Of 665 HIV+ pregnant women, 496 (74.6%) initiated ART. ART initiation increased in later study enrolment phases (mid: aHR: 1.41; later: aHR: 2.36), and decreased at CD4 ≥ 500 (aHR: 0.69). 52.9% were retained in care at 24 months. Attrition was associated with ANC1 in the third trimester (aHR: 2.37), attending a secondary care facility (aHR: 1.98) and ART initiation during later enrolment phases (mid aHR: 1.48; late aHR: 1.67). Of 373 women eligible, 67.3% received a first VL. 223/251 (88.8%) were virologically suppressed (

The salamander plague, caused by the amphibian chytrid fungus Batrachochytrium salamandrivorans (Bsal), is one of the most devastating amphibian diseases, currently threatening the entire Western Palearctic caudate diversity with extinction. Apparently of Asian origin and recently introduced into Europe, Bsal is known from currently ca. 80 sites in the wild in four European countries. Germany is the Bsal 'hotspot', with more than half (N = 50) of all known European records to date. We here present data based on > 8,500 caudate specimens sampled for Bsal mainly via skin swabbing and quantitative real time PCR (> 3,300 since 2019). Within regions of Bsal occurrence ~ 6-7% of the studied caudates were Bsal-positive. The oldest known European record of the pathogen is from this country (2004), but a massive Bsal dispersal has only been recognized within the last five years with 17 new Bsal sites since 2019 alone. Currently, Bsal is spreading within the northern and the southern Eifel and -- since 2017 -- the Ruhr District. Most recently, the pathogen was for the first time detected in southern Germany (Bavaria) and a further range expansion is expected. A new species distribution model (SDM) of Bsal based on > 100 native and invasive records predicts suitable areas in most parts of Germany. Bsal affects all five caudate species known from these regions and has catastrophic effects on the European fire salamander (Salamandra salamandra). All affected populations in Germany (as well as Belgium and The Netherlands) have dramatically declined. While some may have become extinct due to the salamander plague, in most Bsal-positive sites European fire salamanders can still be recorded at low numbers (at least via systematic larval surveys), and at least one population seems to have recovered as currently Bsal detection remains negative. Little is known about the effect of Bsal on newts, and both prevalence and individual infection load can vary greatly over time, even within one population. However, the situation of the northern crested newt (Triturus cristatus) is alarming, as this species also undergoes declines due to Bsal invasions at some sites. Although some anurans are suggested as potential Bsal reservoirs and transmitters, we detected Bsal in only one individual of the common frog (Rana temporaria) out of 365 anurans of various species tested. Co-infection of Bsal with the related chytrid taxon Batrachochytrium dendrobatidis is known from three taxa (S. salamandra, T. cristatus, Ichthyo saura alpestris) and at four sites. The alarming data from Bsal in Germany call for immediate conservation action at all levels, including ex situ conservation. We therefore strongly support the establishment and implementation of a national Bsal Action Plan. [ABSTRACT FROM AUTHOR]

Background: HIV testing at birth may improve early treatment, but concerns remain about feasibility and retention of infants in care. In 2017, point-of-care (POC) HIV birth testing was introduced into routine care at 3 high-volume maternity health facilities in Eswatini. Methods: POC birth testing was offered to HIV-exposed infants (HEI) born at, or presenting to, 3 maternities within 3 days of birth. Data were collected from a project-specific EID test request form and routine registers on all tests conducted from August 1, 2017 to November 30, 2018, including retesting at 6-8 weeks for infants testing negative at birth and six-month retention in HIV care and viral load suppression among infants testing HIV-positive at birth. Results: Of 4322 eligible HEI, 3311 (76.6%) were tested. Twenty-six HIV-infected infants were identified (positivity rate 0.8%) and 25 initiated on antiretroviral therapy (ART) (96.1%). The median time from sample collection to ART initiation was 20.50 days (IQR 14-45). Twenty-one (84%) ART-initiated infants were on ART at 6 months after initiation. Nineteen infants (90.5%) had viral load test information at 6 months and 16 (84.2%) were virally suppressed. Of 3126 HEI testing negative at birth, 3004 (96.1%) were linked to laboratory databases and 2744 (91.3%) were retested at 6-8 weeks, with 9 (0.3%) additional infants testing HIV-positive. Conclusions: Uptake of POC birth testing was high in Eswatini with low HIV positivity. Almost all infants identified HIV-positive at birth were initiated on ART, with high retention in care and viral suppression. Birth testing did not seem to significantly reduce subsequent 6-8-week testing. [ABSTRACT FROM AUTHOR]

• MERS is an emerging infectious disease with high consequences. • PHE Manchester receives a high number of MERS surveillance samples. • Sputum samples are the optimum samples for diagnosing respiratory viruses. • Multiple samples per patient result in a 100% diagnostic yield and a confirmed end-diagnosis. Middle East respiratory syndrome coronavirus (MERS-CoV) emerged in Saudi Arabia in 2012 and caused an epidemic in the Middle East. Public Health England (PHE) Manchester is one of the two PHE centres in the UK that perform testing for MERS-CoV. The results of the PHE Manchester MERS surveillance from 2012 to 2019 are presented in this report. Retrospective data were collected for returning travellers from the Middle East fitting the PHE MERS case definition. Respiratory samples were tested for respiratory viruses and MERS-CoV using an in-house RT-PCR assay. Four hundred and twenty-six (426) samples from 264 patients were tested for MERS Co-V and respiratory viruses. No MERS-CoV infections were identified by PCR. Fifty-six percent of samples were PCR positive for viral or bacterial pathogen with Influenza A as the predominant virus (44%). Sixty-two percent of all patients had a pathogen identified with the highest positivity from sputum samples. Patients with multiple samples demonstrated a 100% diagnostic yield. Although no cases of MERS were identified, the majority of patients had Influenza infection for which oseltamivir treatment was indicated and isolation warranted. Sputum samples were the most useful in diagnosing respiratory viruses with a 100% diagnostic yield from patients with multiple samples. [ABSTRACT FROM AUTHOR]

Background: Early infant diagnosis (EID) of HIV-exposed and initiation of HIV-positive infants on anti-retroviral therapy (ART) requires a well-coordinated cascade of care. Loss-to-follow-up (LTFU) can occur at multiple steps and effective EID is impeded by human resource constraints, difficulty with patient tracking, and long waiting periods. The objective of this research was to conduct formative research to guide the development of an intervention to improve the pediatric HIV care cascade in central Mozambique. The study was conducted in Manica and Sofala Provinces where the adult HIV burden is higher than the national average. The research focused on 3 large clinics in each province, along the highly populated Beira corridor.Methods: The research was conducted in 2014 over 3 months at six facilities and consisted of 1) patient flow mapping and collection of health systems data from postpartum, child-at-risk, and ART service registries, 2) measurement of clinic waiting times, and 3) patient and health worker focus groups.Results: HIV testing and ART initiation coverage for mothers tends to be high, but EID and pediatric ART initiation are hampered by lack of patient tracking, long waiting times, and inadequate counseling to navigate the care cascade. About 76% of HIV-positive infants were LTFU and did not initiate ART.Conclusions: Effective interventions to reduce LTFU in EID and improve pediatric ART initiation should focus on patient tracking, active follow-up of defaulting patients, reduction in EID turn-around times for PCR results, and initiation of ART by nurses in child-at-risk services.Trial Registration: Retrospectively registered, ISRCTN67747315, July 24, 2019. [ABSTRACT FROM AUTHOR]

Greater male partner involvement in Prevention of Mother to Child Transmission (PMTCT) and Early Infant Diagnosis (EID) is associated with improved outcomes. Perceived low social support for the mother can negatively impact the uptake of PMTCT/EID services. Most research relies on women's reports of the types and quality of male partner support received versus what is desired. This qualitative study examines Kenyan male partners' reported social support provision pre- and post-partum from their own perspective. The study was embedded within intervention development studies in Kenya designed to develop and pilot a PMTCT module of a web based system to improve EID. Focus groups were conducted with male partners of pregnant women with HIV and elicited feedback on male partner involvement in maternal and child care and factors affecting participation. Interviews were analyzed within a theoretical social support framework. Participants described providing tangible support (financial resources), informational support (appointment reminders) and emotional support (stress alleviation in the face of HIV-related adversity). African conceptualizations of masculinity and gender norms influenced the types of support provided. Challenges included economic hardship; insufficient social support from providers, peers and bosses; and HIV stigma. Collaboration among providers, mothers and partners; a community-based social support system; and recasting notions of traditional masculinity were identified as ways to foster male partner support. [ABSTRACT FROM AUTHOR]

Summary: Electronic identity is getting an increased importance nowadays since relentless digitalization and 24/7 connectivity continue to transform everyday life. To support the recognition of electronic identification cross‐border within the European Union, the European Commission (EC) released the eIDAS Regulation, which became effective on September 2018. To put eIDAS in practice, the EC has supported the definition of the technical specification; it provides a sample implementation; and it coordinates the eIDAS Network composed of eIDAS nodes of various countries. Each eIDAS node has a generic part required for the communication with the other nodes, and a specific part that each country has to modify independently according to its legal, operational, and technical requirements. Although this specific part is very important because it affects the node flexibility and the interaction with the other actors at the national level, it is less known in practice. We describe the adaptation of this specific part in Italy to perform authentication and provision of attributes through the STORK and STORK 2.0 infrastructures (the predecessors of eIDAS), based on our experience in the homonym projects. Significant effort is spent currently to build real services exploiting the eIDAS infrastructure, eg, the eID4U project proposes eIDAS node extension with new attributes required by some common academic services, such as student registration at a foreign university. We describe the support for these new attributes in the eIDAS nodes and the modification of the specific part of the Italian eIDAS node to allow attributes retrieval from different authorities. [ABSTRACT FROM AUTHOR]

Newcastle Disease Virus (NDV) is the causative agent of the most devastating diseases affecting poultry especially in large scale production causing severe economic losses due to high mortality which may reach 100% in very virulent strains of NDV. In the present study, NDV-suspected samples were isolated in 10 days-old Embryonated chicken Eggs (ECEs) via allantoic cavity for three passages. Viral isolates were identified by Haemagglutination inhibition (HI) test, electron microscope and reverse transcriptase polymerase chain reaction (RT- PCR). The antiviral effects of both onion and garlic extracts were studied on field isolates and reference strain of NDV. The antiviral effects involve the gross lesions changes of the embryo in inoculated ECEs, Haemagglutination (HA) test and Infectivity test (EID50%). The obtained results showed that most of the isolated viruses expressed subcutaneous Haemorrhage and death of the embryo at the fifth day post inoculation via allantoic cavity at the third passage of ECEs, while the field sample number (10) and the reference strain showed extensive haemorrhage and rapid death of embryos. The isolated viruses were identified as NDV of the susceptible to be infected samples by HI using hyperimmune serum against NDV prepared in rabbit. The Mean Death Time (MDT) of the field sample consisting of (10) and the reference strain which showed that the tested samples are velogenic strains was calculated. Electron microscopy investigation of some selected samples (of high HA titers) identified the virus as pleomorphic. Some selected samples were analyzed by RT- PCR and gel electrophoresis to express clear bands by using primers against the F-gene of NDV. Brown leaves of onion (Allium Cepa) and bulbs of garlic (Allium sativum) were separately extracted. These extracts were tested for their antiviral activity against the previously isolated and identified NDV. Investigating the antiviral effects of both onion and garlic extracts on some field samples showed absence of virus activity after treatments by extracts, while samples number (10) and reference strain showed the reduction of virus in HA test, subcutaneous hemorrhage and EID50%. The reduction of NDV infectivity may be due to the blocking of the attachment of the virus with the cell reports. [ABSTRACT FROM AUTHOR]

Here, we present liquid extraction surface analysis (LESA) coupled with electron-induced dissociation (EID) mass spectrometry in a Fourier-transform ion cyclotron resonance mass spectrometer for the analysis of small organic pharmaceutical compounds directly from dosed tissue. First, the direct infusion electrospray ionisation EID and collision-induced dissociation (CID) behaviour of erlotinib, moxifloxacin, clozapine and olanzapine standards were compared. EID mass spectra were also compared with experimental or reference electron impact ionisation mass spectra. The results show that (with the exception of erlotinib) EID and CID result in complementary fragment ions. Subsequently, we performed LESA EID MS/MS and LESA CID MS/MS on singly charged ions of moxifloxacin and erlotinib extracted from a thin tissue section of rat kidney from a cassette-dosed animal. Both techniques provided structural information, with the majority of peaks observed for the drug standards also observed for the tissue-extracted species. Overall, these results demonstrate the feasibility of LESA EID MS/MS of drug compounds from dosed tissue and extend the number of molecular structures for which EID behaviour has been determined.ᅟ [ABSTRACT FROM AUTHOR]

Dialysis dose is an important determinant of clinical outcomes in patients with end stage renal disease on maintenance dialysis. In clinical practice dialysis dose is monitored at least monthly by urea clearance based on Urea Kinetic Modeling. Online clearance monitoring using effective ionic dialysance (EID) of sodium (Na+) is available on some hemodialysis machines. This paper reviews the background, methodology, additional applications, and potential risks associated with EID. Effective ionic dialysance provides a reliable, real‐time, noninvasive, and inexpensive measurement of dialysis dose during an ongoing hemodialysis (HD) session to allow interventions and assess the impact of these changes on clearance. Surveillance of vascular access flow rates can be used to screen for access dysfunction and refer for interventions. There is a concern that EID measurements may cause Na+ loading because of high dialysate Na+ used during these measurements, however, mathematical models, in vitro experiments, and clinical studies in patients on maintenance HD do not show any evidence of Na+ loading during EID measurements. We cannot rule out the possibility of nonosmotic Na+ accumulation in the skin because no published literature exists on this topic as it pertains to clearance measurements based on EID of Na+. [ABSTRACT FROM AUTHOR]

Background The public often turn to social media for information during emerging infectious diseases (EIDs) outbreaks. This study identified the major approaches and assessed the rigors in published research articles on EIDs and social media. Methods We searched 5 databases for published journal articles on EIDs and social media. We then evaluated these articles in terms of EIDs studied, social media examined, theoretical frameworks, methodologic approaches, and research findings. Results Thirty articles were included in the analysis (published between January 1, 2010, and March 1, 2016). EIDs that received most scholarly attention were H1N1 (or swine flu, n = 15), Ebola virus (n = 10), and H7N9 (or avian flu/bird flu, n = 2). Twitter was the most often studied social media (n = 17), followed by YouTube (n = 6), Facebook (n = 6), and blogs (n = 6). Three major approaches in this area of inquiry are identified: (1) assessment of the public's interest in and responses to EIDs, (2) examination of organizations' use of social media in communicating EIDs, and (3) evaluation of the accuracy of EID-related medical information on social media. Conclusions Although academic studies of EID communication on social media are on the rise, they still suffer from a lack of theorization and a need for more methodologic rigor. [ABSTRACT FROM AUTHOR]

Disulfide bond formation is critical for maintaining structure stability and function of many peptides and proteins. Mass spectrometry has become an important tool for the elucidation of molecular connectivity. However, the interpretation of the tandem mass spectral data of disulfide-linked peptides has been a major challenge due to the lack of appropriate tools. Developing proper data analysis software is essential to quickly characterize disulfide-linked peptides. A thorough and in-depth understanding of how disulfide-linked peptides fragment in mass spectrometer is a key in developing software to interpret the tandem mass spectra of these peptides. Two model peptides with inter- and intra-chain disulfide linkages were used to study fragmentation behavior in both collisional-activated dissociation (CAD) and electron-based dissociation (ExD) experiments. Fragments generated from CAD and ExD can be categorized into three major types, which result from different S-S and C-S bond cleavage patterns. DiSulFinder is a computer algorithm that was newly developed based on the fragmentation observed in these peptides. The software is vendor neutral and capable of quickly and accurately identifying a variety of fragments generated from disulfide-linked peptides. DiSulFinder identifies peptide backbone fragments with S-S and C-S bond cleavages and, more importantly, can also identify fragments with the S-S bond still intact to aid disulfide linkage determination. With the assistance of this software, more comprehensive disulfide connectivity characterization can be achieved.ᅟ [ABSTRACT FROM AUTHOR]

Background: Data on the performance and utility of rapid serological tests in infants to determine HIV exposure are unclear and in some instances contradictory. This study sought to understand the performance of rapid serological tests in high HIV burden, high Option B+ coverage settings to be used as an HIV exposure screening tool. Methods: A total of 3600 infants up to 24 months of age at 4 regional hospitals in Uganda were systematically enrolled and tested simultaneously using both HIV rapid serological and nucleic acid- based tests. Results: Only 58 of the 94 HIV-positive infants who received both rapid serological and nucleic acid-based tests were positive with the rapid serological test (sensitivity: 61.7%; 95% confidence interval: 51.1 to 71.5). Using rapid serological tests to screen infants for exposure to HIV and follow-up nucleic acid-based testing would have missed 38.3% (36 of 94) of HIV-positive infants. Finally, several HIV-positive infants who were negative by rapid serological test presented to well-child entry points and were considered healthy. All 3 HIV-positive infants presenting to outreach and immunization were negative by rapid serological testing and 73% (8 of 11) presenting to outpatient. Conclusions: These data suggest that the use of rapid serological tests may have inadequate performance as an indicator of exposure and potential HIV infection among infants presenting at both wellchild (immunization and community outreach) and sick-infant (nutrition and inpatient) entry points. To improve the identification of HIV-positive infants, nucleic acid-based testing should instead be considered in infants aged younger than 18 months. [ABSTRACT FROM AUTHOR]