Blood transfer devices for malaria rapid diagnostic tests : evaluation of accuracy, safety and ease of use

Background: Malaria rapid diagnostic tests (RDTs) are increasingly used by remote health personnel with minimal training in laboratory techniques. RDTs must, therefore, be as simple, safe and reliable as possible. Transfer of blood from the patient to the RDT is critical to safety and accuracy, and poses a significant challenge to many users. Blood transfer devices were evaluated for accuracy and precision of volume transferred, safety and ease of use, to identify the most appropriate devices for use with RDTs in routine clinical care. Methods: Five devices, a loop, straw-pipette, calibrated pipette, glass capillary tube, and a new inverted cup device, were evaluated in Nigeria, the Philippines and Uganda. The 227 participating health workers used each device to transfer blood from a simulated finger-prick site to filter paper. For each transfer, the number of attempts required to collect and deposit blood and any spilling of blood during transfer were recorded. Perceptions of ease of use and safety of each device were recorded for each participant. Blood volume transferred was calculated from the area of blood spots deposited on filter paper. Results: The overall mean volumes transferred by devices differed significantly from the target volume of 5 microliters (p < 0.001). The inverted cup (4.6 microliters) most closely approximated the target volume. The glass capillary was excluded from volume analysis as the estimation method used is not compatible with this device. The calibrated pipette accounted for the largest proportion of blood exposures (23/225, 10%); exposures ranged from 2% to 6% for the other four devices. The inverted cup was considered easiest to use in blood collection (206/ 226, 91%); the straw-pipette and calibrated pipette were rated lowest (143/225 [64%] and 135/225 [60%] respectively). Overall, the inverted cup was the most preferred device (72%, 163/227), followed by the loop (61%, 138/227). Conclusions: The performance of blood transfer devices varied in this evaluation of accuracy, blood safety, ease of use, and user preference. The inverted cup design achieved the highest overall performance, while the loop also performed well. These findings have relevance for any point-of-care diagnostics that require blood sampling.

Geochemistry of evaporite in the Red Sea

One of the major shipboard findings during Leg 23 drilling in the Red Sea was the presence of late Miocene evaporites at Sites 225, 227, and 228. The top of the evaporite sequence correlates with a strong reflector (Reflector S) which has been mapped over much of the Red Sea (Ross et al., 1969, Phillips and Ross, 1970). This indicates that the Red Sea appears to be extent. Miocene sediments, including evaporites, are known from a few outcrops along the coastal plains of the Gulf of Suez to lat 14°N (Sadek, 1959, cited in Friedman, 1972; Heybroek, 1965; Friedman, 1972). Along the length of the Red Sea, the presence of Miocene salt is indicated by seismic reflection studies (Lowell and Genik, 1972) and confirmed by drilling. The recently published data from deep exploratory wells (Ahmed, 1972) demonstrate the great thickness of elastics and evaporites which were deposited in the Red Sea depression during Miocene time. The Red Sea evaporites are of the same age as the evaporites found by deep sea drilling (DSDP Leg 13) in the Mediterranean Sea. Therefore, Reflector S in the Red Sea is comparable to Reflector M in the Mediterranean. It is assumed that during Miocene time a connection between these two basins was established (Coleman, this volume) resulting in a similar origin for the evaporites deposited in the Red Sea and in the Mediterranean Sea. The origin of the Mediterranean evaporites has been discussed in great detail (Hsü et al., 1973; Nesteroff, 1973; Friedman, 1973). The formation of evaporites may be interpreted by three different hypotheses. 1) Evaporation of a shallow restricted shelf sea or lagoon which receives inflows from the open ocean. 2) Evaporation of a deep-water basin which is separated from the open ocean by a shallow sill (Schmalz, 1969). 3) Evaporation of playas or salt lakes which are situated in desiccated deep basins isolated from the open ocean (Hsü et al., 1973). The purpose of this study is to show whether one of these models might apply to the formation and deposition of the Red Sea evaporites. Therefore, a detailed petrographic and geochemical investigation was carried out.