Utility of T-Cell Interferon-γ Release Assays for Etiological Diagnosis of Classic Fever of Unknown Origin in a High Tuberculosis Endemic Area — a pilot prospective cohort

Background

Tuberculosis (TB), especially extrapulmonary TB is still the leading cause of fever of unknown origin (FUO) in China. However, diagnosis of TB still remains a challenge. The aim of this study was to evaluate the diagnostic value of T-SPOT.TB for etiological diagnosis of classic FUO in adult patients in a high TB endemic area.

Methods

We prospectively enrolled patients presenting with classic FUO in a tertiary referral hospital in Beijing, China, to investigate the diagnostic sensitivity, specificity, predictive values and likelihood ratio of T-SPOT.TB. Clinical assessment and T-SPOT.TB were performed. Test results were compared with the final confirmed clinical diagnosis.

Results

387 hospitalized patients (male n = 194, female n = 193; median age 46 (range 29–59) yrs) with classic FUO were prospectively enrolled into this study. These FUOs were caused by infection (n = 158, 40.8%), connective tissue disease (n = 82, 21.2%), malignancy (n = 41, 10.6%) and miscellaneous other causes (n = 31, 8.0%), and no cause was determined in 75 (19.4%) patients. 68 cases were diagnosed as active TB eventually. The sensitivity of T-SPOT.TB for the diagnosis of active TB was 70.6% (95%CI 58.9–80.1%), while specificity was 84.4% (95%CI 79.4–88.4%), positive predictive value was 55.8% (95%CI 45.3–65.8%), negative predictive value was 91.2% (95%CI 86.7–94.2%). Among these 68 active TB patients, 12 cases were culture or histology confirmed (11 cases with positive T-SPOT.TB, sensitivity was 91.7%) and 56 cases were clinically diagnosed (37 cases with positive T-SPOT.TB, sensitivity was 66.1%); 14 cases were pulmonary TB (13 cases with positive T-SPOT.TB, sensitivity was 92.9%) and 54 cases were extrapulmonary TB (35 cases with positive T-SPOT.TB, sensitivity was 64.8%).

Conclusions

For patients presenting with classic FUO in this TB endemic setting, T-SPOT.TB appears valuable for excluding active TB, with a high negative predictive value.     

Some Considerations on Data Integration for the Next-Generation Flora (iFlora) and Flora Revision—— A Case Study of Gaultheria (Ericaceae)

The next-generation intelligent Flora (iFlora) is designed to integrate current botanical knowledge, with molecular biology information and computer technology. The most important and urgent task for iFlora development is to search for an approach to incorporate all useful data into an accurate, most up-to-date and complete information database for a taxon, and hierarchically classify these data to meet different demands from iFlora users, to provide the user an authentic, scientific research based platform for sharing botanic knowledge, and associated valuable information for the benefit of national economy and quality of our life. In this study, we summarized the innovations, hierarchical classifications and functions of data for iFlora, in contrast of that of the previous Floras and the frequently used digital plant databases or eFloras. The innovation and essential of data compilation and integration of the iFlora was emphasized as intelligent assembly of data from DNA barcodes, key morphological characters, digital images and molecular phylogenetics with the support of computer techniques to achieve intelligent plant identification. We attempted to integrate previously assembled research data into the iFlora, and list three hierarchically classified data and their functions, and related issues, with the genus Gaultheria and one of its species, G.hookeri, as test case.     

Detecting Long-term Global Forest Change Using Continuous Fields of Tree-Cover Maps from 8-km Advanced Very High Resolution Radiometer (AVHRR) Data for the Years 1982–99

This paper describes global changes in forest cover from 1982 to 1999 based on the 8-km Pathfinder Advanced Very High Resolution Radiometer (AVHRR) data set. The procedure involves the use of a regression tree in predicting percent tree cover for the years 1982–99. Training data are created from high-resolution imagery and used with phenological metrics derived from the annual AVHRR time series. Using the 18 years of estimated tree cover, and based on a thresholding approach, we identified locations where change in tree cover has occurred. The change sites were then compared to a set of high-resolution deforestation analyses to yield area estimates of deforestation and regrowth. Percent tree cover was found to have decreased globally, from the 1980s to 1990s, in contrast to United Nations Food and Agriculture Organization (FAO) reports of a global increase in forest cover. Latin America and tropical Asia are the two dominant deforestation regions. Paraguay shows the highest rate of forest clearing over the time series, while Indonesia had the greatest increase in deforestation from the 1980s to 1990s. We also suggest that the percent tree-cover maps can be used in standardizing national forest statistics, as an objective means of identifying hot spots of change, and for facilitating ecosystem monitoring.     

In Search for the Genetic Basis of Quality of Life in Healthy Swedish Women—A GWAS Study Using the iCOGS Custom Genotyping Array

Background

Quality of life (QoL) is increasingly measured in both research and clinical practice. QoL-assessments are built on a long, empirically-based, and stringent approach. There is ample evidence that QoL is, in part, heritable. We therefore performed a GWAS relating genetic variation to QoL in healthy females.

Methods

In 5,142 healthy females, background characteristics (e.g. demographic, clinical, lifestyle and psychological factors) and QoL by means of the EORTC QLQ-C30 were measured. Moreover, women were genotyped using a custom array including ~210,000 single nucleotide polymorphisms (SNPs). Initially, SNPs were related to each QoL-domain, by means of partially adjusted (controlling for age and population stratification) and fully adjusted (controlling for age, population stratification, and background characteristics) regression analyses. Additionally, gene-based analyses were performed relating the combined effect of SNPs within each gene to QoL using the statistical software package VEGAS.

Results

None of the associations between QoL and genetic variation (i.e. individual SNPs and genes) reached the bonferroni corrected significance level.

Conclusion

Reasons for a lack of association between genetic markers and QoL could be low variation in QoL-scores; selecting genetic markers not tagging QoL; or that the genetic effect that impacts one’s QoL is mediated through biological pathways rather than the effect of single SNPs or genes. Therefore, we opt for a pathway-based or system biology approach as a complementary and powerful approach to analyze the combined effect of genes and their biological implications in future studies focusing on QoL-issues.     

Determining a Cut-Off Point for Scores of the Breastfeeding Self-Efficacy Scale–Short Form: Secondary Data Analysis of an Intervention Study in Japan

Background

Breastfeeding self-efficacy can be measured with the Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF). Mothers with low BSES-SF scores stop exclusive breastfeeding prematurely, but specific interventions can prevent that undesirable outcome. Because those interventions can be expensive, often one must decide which mothers will receive them. For that purpose, a cut-off BSES-SF score would be useful, but none is available. Therefore, we aimed to assess the overall accuracy of BSES-SF scores as predictors of not practicing post-discharge exclusive breastfeeding, and to choose an appropriate cut-off score for making that prediction.

Methods

This is a secondary data analysis of an intervention study. Data from 378 women in two non-Baby-Friendly Hospitals were analyzed. Participants were women in their third trimester who were 16 years of age or older, were able to read and write Japanese, were expected to have a singleton birth, and had completed the BSES-SF before discharge. BSES-SF scores were measured before discharge. Breastfeeding status was assessed 4 weeks and 12 weeks postpartum. Receiver Operating Characteristic (ROC) curves were used to assess the predictive ability of the BSES-SF and to inform the choice of a cut-off point.

Results

For both of the ROC curves (4 and 12 weeks postpartum) the area under the curve was 0.74. To obtain a high sensitivity, a cut-off score of 50 was chosen. With that cut-off score the sensitivity was 79% and the specificity was 52% 4 weeks postpartum, and they were 77% and 52%, respectively, 12 weeks postpartum.

Conclusion

In conclusion, the BSES-SF has moderate overall accuracy to distinguish women who will not practice exclusive breastfeeding after discharge from those who will. At non-Baby-Friendly hospitals in Japan, interventions to support exclusive breastfeeding might be considered for new mothers who have BSES-SF scores that are less than or equal to 50.     

Attempted Detection of Toxoplasma gondii Oocysts in Environmental Waters Using a Simple Approach to Evaluate the Potential for Waterborne Transmission in the Galápagos Islands,Ecuador

Toxoplasmosis is a health concern for wildlife and humans, particularly in island ecosystems. In the Galápagos Islands, exposure to Toxoplasma gondii has been found in marine avifauna on islands with and without domestic cats. To evaluate potential waterborne transmission of T. gondii, we attempted to use filtration and epifluorescent microscopy to detect autofluorescent T. gondii oocysts in fresh and estuarine surface water samples. T. gondii oocyst-like structures were microscopically visualized but were not confirmed by polymerase chain reaction and sequence analyses. Further research is needed to refine environmental pathogen screening techniques and to evaluate disease risk of waterborne zoonoses such as T. gondii for wildlife and humans, particularly in the Galápagos and other naive island ecosystems.     

High Utility of Contact Investigation for Latent and Active Tuberculosis Case Detection among the Contacts: A Retrospective Cohort Study in Tbilisi,Georgia, 2010–2011

Setting

The study was conducted at the National Center for Tuberculosis and Lung Diseases (NCTBLD) in Tbilisi, Georgia.

Objective

To assess the utility of contact investigation for tuberculosis (TB) case detection. We also assessed the prevalence and risk factors for active TB disease and latent TB infection (LTBI) among contacts of active pulmonary TB cases.

Design

A retrospective cohort study was conducted among the contacts of active pulmonary TB cases registered in 2010–2011 at the NCTBLD in Tbilisi, Georgia. Contacts of active TB patients were investigated according to an “invitation model”: they were referred to the NCTBLD by the index case; were queried about clinical symptoms suggestive of active TB disease; tuberculin skin testing and chest radiographs were performed. Demographic, laboratory, and clinical data of TB patients and their contacts were abstracted from existing records up to February 2013.

Results

869 contacts of 396 index cases were enrolled in the study; a median of 2 contacts were referred per index case. Among the 869 contacts, 47 (5.4%) were found to have or developed active TB disease: 30 (63.8%) were diagnosed with TB during the baseline period (co-prevalent cases) and 17 (36.2%) developed active TB disease during the follow-up period (mean follow up of 21 months) (incident TB cases). The incidence rate of active TB disease among contacts was 1126.0 per 100 000 person years (95% CI 655.7–1802.0 per 100,000 person-years). Among the 402 contacts who had a tuberculin skin test (TST) performed, 52.7% (95% CI 47.7–57.7%) had LTBI.

Conclusions

A high prevalence of LTBI and active TB disease was found among the contacts of TB cases in Tbilisi, Georgia. Our findings demonstrated that an “invitation” model of contact investigation was an effective method of case detection. Therefore, contact investigation should be scaled up in Georgia.     

Effects of Soil Properties on the Transfer of Cadmium from Soil to Wheat in the Yangtze River Delta Region, China—a Typical Industry–Agriculture Transition Area

In order to identify the effects of soil properties on the transfer of Cd from soil to wheat under actual field conditions, 126 pairs of topsoil and wheat samples were collected from the Yangtze River delta region, China. Relevant parameters (Cd, Ca, Mg, Fe, Mn, Zn, N, P, K, S, pH, total organic carbon, and speciation of soil Cd) in soil and wheat tissues were analyzed, and the results were treated by statistical methods. Soil samples (19.8%) and 14.3% of the wheat grain samples exceeded the relevant maximum permissible Cd concentrations in China for agricultural soil and wheat grain, respectively. The major speciations of Cd in soil were exchangeable, bound to carbonates and fulvic and humic acid fraction, and they were readily affected by soil pH, total Ca, Mg, S and P, DTPA-Fe, Ex-Ca, and Ex-Mg. Cadmium showed a strong correlation with Fe, S, and P present in the grain and the soil, whereas there was no significant correlation in the straw or root. Generally, soil pH, Ca, Mg, Mn, P, and slowly available K restricted Cd transfer from soil to wheat, whereas soil S, N, Zn, DTPA-Fe, and total organic carbon enhance Cd uptake by wheat.     

A new mechanism for adaptation to changes in light intensity and quality in the red alga,Porphyra perforata. II. Characteristics of state II—state III transitions

Characteristics of state II—state III transitions in the red alga, Porphyra perforata, were studied by measuring the fluorescence time course at room temperature and fluorescence spectra at 77 K. The state II to III transition was induced by system II light and was sensitive to uncouplers of photophosphorylation. This state II to III transition has a dark step(s) that could be easily separated from the light process. A state III to II transition occurred in the dark, but system I light accelerated the transition. The accelerating effect of system I light was not sensitive to uncouplers of photophosphorylation, but was inhibited by the addition of valinomycin + KCl or antimycin A. Compared to state I—state II transitions, the state II—state III transitions occurred more rapidly. The state II to state III transitions are different from the state I to state II transitions in that in state III the activity of photosystem II is changed without having any effect on photosystem I activity (Satoh and Fork, Biochim. Biophys, Acta, in press, 1982). It is suggested that the state II—state III transition represents a mechanism by which the alga can avoid photodamage resulting from absorption of excess light energy by photosystem II.     

APstI polymorphism detects the mutation of serine128 to arginine in CD 62E gene — a risk factor for coronary artery disease

The mutation of serine₁₂₈ to arginine in the CD 62E gene is a risk factor for coronary artery disease (CAD). We designed a new method to detect this mutation based on the observation that it is due to a transversion of nucleotide A₅₆₁ to C, which abolishes aPstI recognition site. Two alleles, A and C, are easily typed when genomic DNA is amplified by PCR, digested withPstI, and separated on agarose gels. Among 153 people who underwent an elective, diagnostic arteriography in Johns Hopkins Hospital, we found that the C allele accounts for 19.5% in angiographically documented CAD patients (n=82). It is significantly higher than the 10.6% frequency observed in normal controls (n=71, p<0.05). It indicates that the C allele is associated with early-onset CAD. This new method should facilitate the screening of this mutant allele in large populations and contribute to the understanding of the molecular mechanism underlying the association of this mutation with CAD.     

Study protocol of “CHAPS”: a randomized controlled trial protocol of Care Coordination for Health Promotion and Activities in Parkinson’s Disease to improve the quality of care for individuals with Parkinson’s disease

Background

Parkinson’s disease, the second most common neurodegenerative disease, is diagnostically defined by motor impairments, but also includes often under-recognized impairments in cognition, mood, sleep, and the autonomic nervous system. These problems can severely affect individuals’ quality of life. In our prior research, we have developed indicators to measure the quality of care delivered to patients with Parkinson’s disease, and we identified gaps in delivering evidence-based treatments for this population. Effective strategies to close these gaps are needed to improve patient quality of life.

Methods/design

Building on prior research we developed a multi-faceted proactive implementation program called Care Coordination for Health Promotion and Activities in Parkinson’s Disease (CHAPS). To be eligible, patients had to have at least two visits with a primary diagnosis of idiopathic Parkinson’s disease (ICD-9 code: 332.0) at one of five Veterans Affairs Medical Centers in the southwestern United States from 2010 to 2014. The program consists of telephone assessments, evidence-based protocols, and tools to enhance patient self-management, care planning, and coordination of care across providers, including an electronic database to support and track coordination of care. Our mixed-methods study employs a randomized, controlled trial design to test whether the CHAPS intervention improves performance in 38 quality measures among an analytic sample of 346 patients. The 38 quality measures are categorized into overarching areas of communication, education, and continuity; regulatory reporting; diagnosis; periodic assessment; medication use; management of motor and non-motor symptoms; use of non-pharmacological approaches and therapies; palliative care; and health maintenance. Secondary outcomes are patient health-related quality of life, self-efficacy, and perceptions of care quality. We are also evaluating the extent of the CHAPS Program implementation and measuring program costs and impacts on health services utilization, in order to perform a analysis of the CHAPS program from the perspective of the Veterans Health Administration (VA). Outcomes are assessed by interviewer-administered surveys collected at baseline and at 6, 12, and 18 months, and by medical record chart abstractions. Analyses will be intention-to-treat.

Discussion

The CHAPS Program is poised for dissemination within the VA National Parkinson’s Disease Research, Education, and Clinical Center Consortium if demonstrated efficacious.

Trial Registration

ClinicalTrials.gov NCT01532986; registered on January 13, 2012.

     

“I Do Feel Like a Scientist at Times”: A Qualitative Study of the Acceptability of Molecular Point-Of-Care Testing for Chlamydia and Gonorrhoea to Primary Care Professionals in a Remote High STI Burden Setting

Background

Point-of-care tests for chlamydia (CT) and gonorrhoea (NG) could increase the uptake and timeliness of testing and treatment, contribute to improved disease control and reduce reproductive morbidity. The GeneXpert (Xpert CT/NG assay), suited to use at the point-of-care, is being used in the TTANGO randomised controlled trial (RCT) in 12 remote Australian health services with a high burden of sexually transmissible infections (STIs). This represents the first ever routine use of a molecular point-of-care diagnostic for STIs in primary care. The purpose of this study was to explore the acceptability of the GeneXpert to primary care staff in remote Australia.

Methods

In-depth qualitative interviews were conducted with 16 staff (registered or enrolled nurses and Aboriginal Health Workers/Practitioners) trained and experienced with GeneXpert testing. Interviews were digitally-recorded and transcribed verbatim prior to content analysis.

Results

Most participants displayed positive attitudes, indicating the test was both easy to use and useful in their clinical context. Participants indicated that point-of-care testing had improved management of STIs, resulting in more timely and targeted treatment, earlier commencement of partner notification, and reduced follow up efforts associated with client recall. Staff expressed confidence in point-of-care test results and treating patients on this basis, and reported greater job satisfaction. While point-of-care testing did not negatively impact on client flow, several found the manual documentation processes time consuming, suggesting that improved electronic connectivity and test result transfer between the GeneXpert and patient management systems could overcome this. Managing positive test results in a shorter time frame was challenging for some but most found it satisfying to complete episodes of care more quickly.

Conclusions

In the context of a RCT, health professionals working in remote primary care in Australia found the GeneXpert highly acceptable. These findings have implications for use in other primary care settings around the world.     

Comparing the effectiveness of copper intrauterine devices available in Canada. Is FlexiT non-inferior to NovaT when inserted immediately after first-trimester abortion? Study protocol for a randomized controlled trial

ABSTRACT: BACKGROUND: We describe the rationale and protocol for a randomized noninferiority controlled trial (RCT) to determine if the Flexi-T380(+) copper intrauterine contraceptive device (IUD) is comparable in terms of effectiveness and expulsion rates to the most common Canadian IUD currently in use, NovaT-200, when placed immediately after a first-trimester abortion. METHODS: Consenting women choosing to use an IUD after an abortion for a pregnancy of less than 12 weeks of gestation will be randomized to device-type groups to receive immediate post-abortion placement of either a Flexi-T380(+) IUD, a device for which no current evidence on expulsion or effectiveness rates is available, or the Nova-T200 IUD, the only other brand of copper IUD available in Canada at the time of study initiation. The primary outcome measure is IUD expulsion rate at 1 year. Secondary outcomes include: pregnancy rate, method continuation rate, complication rates (infection, perforation), and satisfaction with contraceptive method. A non-intervention group of consenting women choosing a range of other post-abortion contraception methods, including no contraception, will be included for comparison of secondary outcomes. Web-based contraception satisfaction questionnaires, clinical records, and government-linked health administrative databases will be used to assess primary and secondary outcomes. DISCUSSION: The RCT design, combined with access to clinical records at all provincial abortion clinics, and to information in provincial single-payer linked administrative health databases, birth registry, and hospital records, offers a unique opportunity to determine if a novel IUD has a comparable expulsion rate to that of the current standard IUD in Canada, in addition to the first opportunity to determine pregnancy rate and method satisfaction at 1 year post-abortion for women choosing a range of post-abortion contraceptive options. We highlight considerations of design, implementation, and evaluation of the first trial to provide rigorous evidence for the effectiveness of current Canadian IUDs when inserted after first-trimester abortion.Trial registrationClinicalTrials.gov Identifier NCT01174225.     

Both completing system boundaries and realistic modeling of the economy are of interest for life cycle assessment—a reply to “Moving from completing system boundaries to more realistic modeling of the economy in life cycle assessment” by Yang and Heijungs (2018)

The International Journal of Life Cycle Assessment - As Yang and Heijungs (Int J Life Cycle Assess https://doi.org/10.1007/s11367-018-1532-y , 2018) bring forward, there is indeed a need for...