Metaanalysis of the Performance of a Combined Treponemal and Nontreponemal Rapid Diagnostic Test for Syphilis and Yaws.

BACKGROUND: The human treponematoses are important causes of disease. Mother-to-child transmission of syphilis remains a major cause of stillbirth and neonatal death. There are also almost 100 000 cases of endemic treponemal disease reported annually, predominantly yaws. Rapid diagnostic tests (RDTs) would improve access to screening for these diseases. Most RDTs cannot distinguish current and previous infection. The Dual Path Platform (DPP) Syphilis Screen & Confirm test includes both a treponemal (T1) and nontreponemal (T2) component and may improve the accuracy of diagnosis. METHODS: We conducted a metaanalysis of published and unpublished evaluations of the DPP-RDT for the diagnosis of syphilis and yaws. We calculated the sensitivity, specificity, and overall agreement of the test compared with reference laboratory tests. RESULTS: Nine evaluations, including 7267 tests, were included. Sensitivity was higher in patients with higher titer rapid plasma reagin (≥1:16) for both the T1 (98.2% vs 90.1%, P < .0001) and the T2 component (98.2% vs 80.6%, P < .0001). Overall agreement between the DPP test and reference serology was 85.2% (84.4%-86.1%). Agreement was highest for high-titer active infection and lowest for past infection. CONCLUSIONS: The RDT has good sensitivity and specificity of the treponemal and nontreponemal components both in cases of suspected syphilis and yaws, although the sensitivity is decreased at lower antibody titers.

Evaluation of Multiplex-Based Antibody Testing for Use in Large-Scale Surveillance for Yaws: a Comparative Study.

WHO has targeted yaws for global eradication by 2020. The program goals are to interrupt the transmission in countries where yaws is endemic and to certify countries as yaws free where yaws was endemic in the past. No new rapid plasmin reagin (RPR) seroreactivity in young children is required for certification of elimination at a country level. We sought to evaluate whether antibody responses to specific treponemal antigens measured in a high-throughput multiplex bead array (MBA) assay differentiate past versus current infection and whether a nontreponemal lipoidal antigen test can be incorporated into the MBA. Serum and dried blood spot specimens collected for yaws surveillance projects in Ghana, Vanuatu, and Papua New Guinea (PNG) were run on MBA to measure antibodies against recombinant p17 (rp17) and treponemal membrane protein A (TmpA) treponemal antigens. Results were compared to standard treponemal laboratory (TPPA or TPHA [TPP(H)A]) and quantitative RPR test data. Of 589 specimens, 241 were TPP(H)A(+)/RPR(+), 88 were TPP(H)A(+)/RPR(-), 6 were TPP(H)A(-)/RPR(+), and 254 were negative for both tests. Compared to TPP(H)A, reactive concordance of rp17 was 93.7%, while reactive concordance of TmpA was only 81.9%. TmpA-specific reactivity showed good correlation with RPR titers (R(2) = 0.41; P < 0.0001). IgG responses to the lipoidal antigen used in RPR testing (cardiolipin) were not detected in the MBA. Our results suggest that TmpA can be used as a treponemal antigen marker for recent or active infection and potentially replace RPR in a high-throughput multiplex tool for large-scale yaws surveillance.

Managerial and Organizational Discourses of Workplace Bullying.

OBJECTIVE: To explore how workplace bullying is addressed by hospital nursing unit managers and organizational policies. BACKGROUND: Although workplace bullying is costly to organizations, nurses report that managers do not consistently address the issue. METHODS: This study used discourse analysis to analyze interview data and policy documents. RESULTS: There were differences in the manner in which managers and the policy documents labeled bullying-type behaviors and discussed the roles and responsibilities of staff and managers. Policies did not clearly delineate how managers should respond to workplace bullying. CONCLUSIONS: These differences can allow management variation, not sanctioned by policy. Unclear policy language can also offer insufficient guidance to managers, resulting in differential enforcement of policies.

Effect of multiple freeze and thaw cycles on the sensitivity of IgG and IgM immunoglobulins in the sera of patients with syphilis.

We describe the effects of multiple freeze and thaw cycles on the sensitivity of the immunoglobulins IgG and IgM measured by enzyme-linked immunoassays in the sera of patients with syphilis. Stored frozen sera can withstand repeated freezing and thawing cycles with a minimal detrimental effect on the sensitivity of the sera.

Evaluation of a digital flocculation reader for the rapid plasma reagin test for the serological diagnosis of syphilis.

We described the ASiManager-AT digital flocculation reader to demonstrate concordance between visual and digital readings of the rapid plasma reagin test for detection of antibodies in the serum of patients with syphilis. A qualitative and quantitative rapid plasma reagin was performed on each serum samples giving a concordance of 98.6% and 99.7%, respectively, for reactives and 100% for nonreactives.

Laboratory-confirmed case of yaws in a 10-year-old boy from the Republic of the Congo.

We report a case of yaws in a patient with puritic cutaneous eruption who was initially suspected of infection with monkeypox. The diagnosis was established by real-time PCR and sequencing of specific treponemal DNA sequences. This is the first report describing the use of DNA sequencing to identify Treponema pallidum subsp. pertenue-specific sequences in a patient with active yaws.

Novel point-of-care test for simultaneous detection of nontreponemal and treponemal antibodies in patients with syphilis.

We describe a point-of-care immunochromatographic test for the simultaneous detection of both nontreponemal and treponemal antibodies in the sera of patients with syphilis that acts as both a screening and a confirmatory test. A total of 1,601 banked serum samples were examined by the dual test, and the results were compared to those obtained using a quantitative rapid plasma reagin (RPR) test and the Treponema pallidum passive particle agglutination (TP-PA) assay. Compared to the RPR test, the reactive concordance of the dual test nontreponemal line was 98.4% when the RPR titers of sera were ≥1:2 and the nonreactive concordance was 98.6%. Compared to the TP-PA assay, the reactive and nonreactive concordances of the treponemal line were 96.5% and 95.5%, respectively. These results indicate that the dual test could be used for the serological diagnosis of syphilis in primary health care clinics or resource-poor settings and therefore improve rates of treatment where patients may fail to return for their laboratory results.

The potential of backscattering interferometry as an in vitro clinical diagnostic tool for the serological diagnosis of infectious disease.

Backscattering interferometry enables the detection of syphilis antibody-antigen interactions in the presence of human serum, showing promise as a diagnostic tool for the serological diagnosis of infectious disease with potentially quantitative capabilities.

Workplace discrimination and health among Filipinos in the United States.

OBJECTIVES: We examined the association between work discrimination and morbidity among Filipinos in the United States, independent of more-global measures of discrimination. METHODS: Data were collected from the Filipino American Community Epidemiological Survey. Our analysis focused on 1652 participants who were employed at the time of data collection, and we used negative binomial regression to determine the association between work discrimination and health conditions. RESULTS: The report of workplace discrimination specific to being Filipino was associated with an increased number of health conditions. This association persisted even after we controlled for everyday discrimination, a general assessment of discrimination; job concerns, a general assessment of unpleasant work circumstances; having immigrated for employment reasons; job category; income; education; gender; and other sociodemographic factors. CONCLUSIONS: Racial discrimination in the workplace was positively associated with poor health among Filipino Americans after we controlled for reports of everyday discrimination and general concerns about one's job. This finding shows the importance of considering the work setting as a source of discrimination and its effect on morbidity among racial minorities.

Measuring emotional labor among young workers: refinement of the Emotions at Work Scale.

This analysis examines the applicability of the emotional labor scale from the Emotions at Work Scale (EWS) through the assessment of its psychometric properties in a sample of young workers. Factor analysis and test-retest reliability were conducted on a 13-item scale measuring emotional labor. The EWS 13-item emotional labor scale was refined to 9 items. Two subscales were delineated: 5 items measured surface acting and 4 items measured deep acting, each with a mean inter-item correlation of 0.33. Cronbach's alpha was .96 for the 9-item scale, and .71 and .67 for the surface acting and deep acting subscales, respectively. Test-retest reliability was 0.64 for surface acting and 0.51 for deep acting during a mean interval of 3 months. Emotional labor can be quantitatively measured among young workers using the derived 9-item scale, although additional studies further evaluating its use should be conducted.

Laboratory evaluation of the Chembio Dual Path Platform HIV-Syphilis Assay.

BACKGROUND: Use of rapid diagnostic tests for HIV and syphilis has increased remarkably in the last decade. As new rapid diagnostic tests become available, there is a continuous need to assess their performance and operational characteristics prior to use in clinical settings. OBJECTIVES: In this study, we evaluated the performance of the Chembio Dual Path Platform (DPP®) HIV-Syphilis Assay to accurately diagnose HIV, syphilis, and HIV/syphilis co-infection. METHOD: In 2013, 990 serum samples from the Georgia Public Health Laboratory in Atlanta, Georgia, United States were characterised for HIV and syphilis and used to evaluate the platform. HIV reference testing combined third-generation Enzyme Immunoassay and Western Blot, whereas reference testing for syphilis was conducted by the Treponema pallidum passive particle agglutination method and the TrepSure assay. We assessed the sensitivity and specificity of the DPP assay on this panel by comparing results with the HIV and syphilis reference testing algorithms. RESULTS: For HIV, sensitivity was 99.8% and specificity was 98.4%; for syphilis, sensitivity was 98.8% and specificity was 99.4%. Of the 348 co-infected sera, 344 (98.9%) were detected accurately by the DPP assay, but 11 specimens had false-positive results (9 HIV and 2 syphilis) due to weak reactivity. CONCLUSION: In this evaluation, the Chembio DPP HIV-Syphilis Assay had high sensitivity and specificity for detecting both HIV and treponemal antibodies. Our results indicate that this assay could have a significant impact on the simultaneous screening of HIV and syphilis using a single test device for high-risk populations or pregnant women needing timely care and treatment.

The youth work force: unique occupational health considerations and challenges.

During the past decade, the characteristics and number of adolescent workers has changed little. Several studies were conducted during this time documenting the patterns, scope, and effect of work among young individuals in the United States. Part-time employment may benefit youth by imparting positive work values, reinforcing the importance of academic skills for future career success, providing a better understanding of the workplace, increasing contact with adults, and building character. Negative aspects of youth employment include threats to completion of developmental tasks and education, injury, toxic exposure, and illness. The enactment of regulations and resulting change in the nature of youth employment has contributed to a substantial decrease in youth-related occupational fatality and injury. However, youth workers continue to suffer fatal and nonfatal occupational injuries with most injuries occurring in the retail industry. Efforts should be made to develop innovative interventions tailored to young workers that focus on surveillance, advocacy, education, and research to decrease workplace injury and illness.

An Investigation of Organizational and Regulatory Discourses of Workplace Bullying.

Organizations use policies to set standards for employee behaviors. Although many organizations have policies that address workplace bullying, previous studies have found that these policies affect neither workplace bullying for targets who are seeking assistance in ending the behaviors nor managers who must address incidents of bullying. This article presents the findings of a study that used critical discourse analysis to examine the language used in policies written by health care organizations and regulatory agencies to regulate workplace bullying. The findings suggest that the discussion of workplace bullying overlaps with discussions of disruptive behaviors and harassment. This lack of conceptual clarity can create difficulty for managers in identifying, naming, and disciplining incidents of workplace bullying. The documents also primarily discussed workplace bullying as a patient safety concern. This language is in conflict with organizations attending to worker well-being with regard to workplace bullying.

An Exploration of Managers' Discourses of Workplace Bullying.

AIM: To identify discourses used by hospital nursing unit managers to characterize workplace bullying, and their roles and responsibilities in workplace bullying management. BACKGROUND: Nurses around the world have reported being the targets of bullying. These nurses often report that their managers do not effectively help them resolve the issue. There is scant research that examines this topic from the perspective of managers. METHODS: This was a descriptive, qualitative study. Interviews were conducted with hospital nursing unit managers who were recruited via purposive and snowball sampling. Data were analyzed using Willig's Foucauldian discourse analysis. RESULTS: Managers characterized bullying as an interpersonal issue involving the target and the perpetrator, as an intrapersonal issue attributable to characteristics of the perpetrator, or as an ambiguous situation. For interpersonal bullying, managers described supporting target's efforts to end bullying; for intrapersonal bullying, they described taking primary responsibility; and for ambiguous situations, they described several actions, including doing nothing. CONCLUSION: Managers have different responses to different categories of bullying. Efforts need to be made to make sure they are correctly identifying and appropriately responding to incidents of workplace bullying.

A smartphone dongle for diagnosis of infectious diseases at the point of care.

This work demonstrates that a full laboratory-quality immunoassay can be run on a smartphone accessory. This low-cost dongle replicates all mechanical, optical, and electronic functions of a laboratory-based enzyme-linked immunosorbent assay (ELISA) without requiring any stored energy; all necessary power is drawn from a smartphone. Rwandan health care workers used the dongle to test whole blood obtained via fingerprick from 96 patients enrolling into care at prevention of mother-to-child transmission clinics or voluntary counseling and testing centers. The dongle performed a triplexed immunoassay not currently available in a single test format: HIV antibody, treponemal-specific antibody for syphilis, and nontreponemal antibody for active syphilis infection. In a blinded experiment, health care workers obtained diagnostic results in 15 min from our triplex test that rivaled the gold standard of laboratory-based HIV ELISA and rapid plasma reagin (a screening test for syphilis), with sensitivity of 92 to 100% and specificity of 79 to 100%, consistent with needs of current clinical algorithms. Patient preference for the dongle was 97% compared to laboratory-based tests, with most pointing to the convenience of obtaining quick results with a single fingerprick. This work suggests that coupling microfluidics with recent advances in consumer electronics can make certain laboratory-based diagnostics accessible to almost any population with access to smartphones.

Emotional labor: relevant theory for occupational health practice in post-industrial America.

The occupational experience of workers in service-oriented jobs can have profound effects on their health and well being, such as burnout, inauthenticity, and job dissatisfaction. The growing service economy and resultant proliferation of service-oriented jobs in current times and in the future must be acknowledged and investigated. The move from an economy driven by manufacturing industries to one dominated by service industries has taken place and currently prevails in the United States. In recognizing this shift in the "work" experience of the American work force, the changing nature of work related hazards must also be considered. Emotional labor has come to be known as an appreciable aspect of work involving direct interactions with clients and customers that can lead to adverse psychosocial outcomes. These relationships reveal the potential unpleasantness of service employment in which the performance of emotional labor is unavoidable. Although worker attributes can influence the emotional experience on the job, emotional labor is also likely to threaten the well being of workers through significantly high demands to express organizationally desired emotions and low control over what emotions can be felt and displayed. Recognition and investigation of emotional labor is necessary to understand its effects on worker populations. Conceptual models featuring emotional labor are available to guide research. However, discrimination among them based on utility and application in relation to identified study objectives and needs is essential.

A comparison of the analytical level of agreement of nine treponemal assays for syphilis and possible implications for screening algorithms.

OBJECTIVE: The serological diagnosis of syphilis requires the detection of two distinct antibodies, the non-treponemal and trepomenal. Center for Disease Control and Prevention (CDC) recommends screening first with a non-treponemal test such as (Rapid Plasma Reagin/Venereal Disease Research Laboratory), and then confirming those results with one of the several treponemal tests (Fluorescent Treponemal Antibody-Absorption (FTA-ABS), Enzyme Immunoassay, chemiluminescence, treponema pallidum particle agglutination (TP-PA) or Point of Care). Owing to the high volume of samples processed by some laboratories using automated systems, the screening with treponemal assays and confirming with non-treponemal tests is becoming the established norm. The purpose of this study was to evaluate eight treponemal assays using TP-PA as the predicate assay. METHODS: 290 stored serum samples were tested qualitatively according to the manufacturer's directions. RESULTS: Concordance with specimens tested as reactive or non-reactive using TP-PA was: FTA-ABS 94.5-100%, Trep-Sure 100-98.9%, BioELISA 100-98.9%, INNO-LIA 99.1-99.4%, BIOLINE 100-98.9%, CAPTIA IgG 100-97.2%, Trep-ID 100-100% and LIAISON 100-99.4%. In order to properly evaluate the performance of these assays, the analytical sensitivity was determined by endpoint titration of serial dilutions of the reactive serum samples in normal sera. The median endpoint titre varied from 1:4 for FTA-ABS to 1:512 for Trep-Sure. CONCLUSIONS: The performance of the treponemal serological assays was comparable while using medium and high-titre sera. However, the varying performance on specimen dilutions suggests that there may be differences in sensitivity with low-titre sera that are more prevalent in primary and late syphilis cases.

How immigrant workers experience workplace problems: a qualitative study.

In this qualitative study, the authors describe work organization factors, problems workers encounter on the job, consequences of these problems, and actions taken to deal with them. Study participants were immigrant workers seeking assistance at the Chicago Interfaith Workers' Rights Center. Using a grounded theory approach, the investigators coded narratives from 455 records describing workers' problems. Emerged sequences of events were then integrated into a model. Data show that workers' rights are systematically violated and problems are rooted in how jobs are designed and managed. Work organization factors are associated with occupational injury/illness, job loss, and worker actions. Employer responses included indifference and various forms of retaliation. This model provides insight into the work-related troubles immigrants face and informs hypothesis generation and action initiatives.

Prioritizing safe patient handling: The American Nurses Association's Handle With Care Campaign.

Nurses continue to suffer debilitating injuries secondary to manual patient handling. Patient care ergonomics has emerged to redesign patient care with reduced exposure to physical hazards. Safe patient handling programs are being increasingly accepted by healthcare organizations to prevent occupational injury and to enhance patient safety. The authors discuss national-level efforts to promote patient care ergonomics principles and safe patient handling programs and their impact on nursing shortages and quality patient care.

Defibrination of blood plasma for use in serological tests for syphilis.

Syphilitic plasma can be salvaged from discarded blood donations and converted to serum by defibrination. Sixty-nine units of plasma were treated with a stock solution of 100 U of thrombin per ml in 1 M calcium chloride and then with a 10% (wt/vol) solution of kaolin. Fibrinogen concentrations detected in initial plasma samples ranged from 94 to 4970 mg/liter (mean, 2532 mg/liter) for samples that were reactive by the rapid plasma reagin circle card test (RPR) and from 314 to 2742 mg/liter (mean 1528 mg/liter) for samples that were not reactive by the RPR. The treated samples showed no measurable fibrinogen remaining after the defibrination process. In the nontreponemal RPR for syphilis, 86% of the treated plasma samples retained the same endpoint titer as that of the initial plasma sample. When the Treponema pallidum passive-particle-agglutination test was used, 98% retained the same reactivity. In the Captia Syphilis-G enzyme immunoassay, 89% of the treated samples demonstrated no change in reactivity index, and in the fluorescent treponemal antibody absorption test, 96% showed no reduction in fluorescence. Human sera containing antibodies to syphilis are used at the Centers for Disease Control and Prevention for the preparation of reference controls or as samples for proficiency testing. Finding reactive sera is becoming more difficult due to the general decline of syphilis cases in the United States. The decreasing availability of these sera can be alleviated by salvaging plasma and converting it to serum.