Rapid tests and urine sampling techniques for the diagnosis of urinary tract infection (UTI) in children under five years: a systematic review

Background: Urinary tract infection (UTI) is one of the most common sources of infection in children under five. Prompt diagnosis and treatment is important to reduce the risk of renal scarring. Rapid, cost-effective, methods of UTI diagnosis are required as an alternative to culture. Methods: We conducted a systematic review to determine the diagnostic accuracy of rapid tests for detecting UTI in children under five years of age. Results: The evidence supports the use of dipstick positive for both leukocyte esterase and nitrite (pooled LR+ = 28.2, 95% CI: 17.3, 46.0) or microscopy positive for both pyuria and bacteriuria (pooled LR+ = 37.0, 95% CI: 11.0, 125.9) to rule in UTI. Similarly dipstick negative for both LE and nitrite (Pooled LR- = 0.20, 95% CI: 0.16, 0.26) or microscopy negative for both pyuria and bacteriuria (Pooled LR- = 0.11, 95% CI: 0.05, 0.23) can be used to rule out UTI. A test for glucose showed promise in potty-trained children. However, all studies were over 30 years old. Further evaluation of this test may be useful. Conclusion: Dipstick negative for both LE and nitrite or microscopic analysis negative for both pyuria and bacteriuria of a clean voided urine, bag, or nappy/pad specimen may reasonably be used to rule out UTI. These patients can then reasonably be excluded from further investigation, without the need for confirmatory culture. Similarly, combinations of positive tests could be used to rule in UTI, and trigger further investigation

How does study quality affect the results of a diagnostic meta-analysis?

Background: The use of systematic literature review to inform evidence based practice in diagnostics is rapidly expanding. Although the primary diagnostic literature is extensive, studies are often of low methodological quality or poorly reported. There has been no rigorously evaluated, evidence based tool to assess the methodological quality of diagnostic studies. The primary objective of this study was to determine the extent to which variations in the quality of primary studies impact the results of a diagnostic meta-analysis and whether this differs with diagnostic test type. A secondary objective was to contribute to the evaluation of QUADAS, an evidence-based tool for the assessment of quality in diagnostic accuracy studies. Methods: This study was conducted as part of large systematic review of tests used in the diagnosis and further investigation of urinary tract infection (UTI) in children. All studies included in this review were assessed using QUADAS, an evidence-based tool for the assessment of quality in systematic reviews of diagnostic accuracy studies. The impact of individual components of QUADAS on a summary measure of diagnostic accuracy was investigated using regression analysis. The review divided the diagnosis and further investigation of UTI into the following three clinical stages: diagnosis of UTI, localisation of infection, and further investigation of the UTI. Each stage used different types of diagnostic test, which were considered to involve different quality concerns. Results: Many of the studies included in our review were poorly reported. The proportion of QUADAS items fulfilled was similar for studies in different sections of the review. However, as might be expected, the individual items fulfilled differed between the three clinical stages. Regression analysis found that different items showed a strong association with test performance for the different tests evaluated. These differences were observed both within and between the three clinical stages assessed by the review. The results of regression analyses were also affected by whether or not a weighting (by sample size) was applied. Our analysis was severely limited by the completeness of reporting and the differences between the index tests evaluated and the reference standards used to confirm diagnoses in the primary studies. Few tests were evaluated by sufficient studies to allow meaningful use of meta-analytic pooling and investigation of heterogeneity. This meant that further analysis to investigate heterogeneity could only be undertaken using a subset of studies, and that the findings are open to various interpretations. Conclusion: Further work is needed to investigate the influence of methodological quality on the results of diagnostic meta-analyses. Large data sets of well-reported primary studies are needed to address this question. Without significant improvements in the completeness of reporting of primary studies, progress in this area will be limited

Neuroleptic-induced movement disorders in a naturalistic schizophrenia population: diagnostic value of actometric movement patterns

<p>Abstract</p> <p>Background</p> <p>Neuroleptic-induced movement disorders (NIMDs) have overlapping co-morbidity. Earlier studies have described typical clinical movement patterns for individual NIMDs. This study aimed to identify specific movement patterns for each individual NIMD using actometry.</p> <p>Methods</p> <p>A naturalistic population of 99 schizophrenia inpatients using conventional antipsychotics and clozapine was evaluated. Subjects with NIMDs were categorized using the criteria for NIMD found in the Diagnostic and Statistical Manual for Mental Disorders – Fourth Edition (DSM-IV).</p> <p>Two blinded raters evaluated the actometric-controlled rest activity data for activity periods, rhythmical activity, frequencies, and highest acceleration peaks. A simple subjective question was formulated to test patient-based evaluation of NIMD.</p> <p>Results</p> <p>The patterns of neuroleptic-induced akathisia (NIA) and pseudoakathisia (PsA) were identifiable in actometry with excellent inter-rater reliability. The answers to the subjective question about troubles with movements distinguished NIA patients from other patients rather well. Also actometry had rather good screening performances in distinguishing akathisia from other NIMD. Actometry was not able to reliably detect patterns of neuroleptic-induced parkinsonism and tardive dyskinesia.</p> <p>Conclusion</p> <p>The present study showed that pooled NIA and PsA patients had a different pattern in lower limb descriptive actometry than other patients in a non-selected sample. Careful questioning of patients is a useful method of diagnosing NIA in a clinical setting.</p

Analysis of gaseous ammonia (NH3) absorption in the visible spectrum of Jupiter

Observations of the visible/near-infrared reflectance spectrum of Jupiter have been made with the Very Large Telescope (VLT) Multi Unit Spectroscopic Explorer (MUSE) instrument in the spectral range 0.48 – 0.93 μm in support of the NASA/Juno mission. These spectra contain spectral signatures of gaseous ammonia (NH3), whose abundance above the cloud tops can be determined if we have reliable information on its absorption spectrum. While there are a number of sources of NH3 absorption data in this spectral range, they cover small sub-ranges, which do not necessarily overlap and have been determined from a variety of sources. There is thus considerable uncertainty regarding the consistency of these different sources when modelling the reflectance of the entire visible/near-IR range. In this paper we analyse the VLT/MUSE observations of Jupiter to determine which sources of ammonia absorption data are most reliable. We find that the band model coefficients of Bowles et al. (2008) provide, in general, the best combination of reliability and wavelength coverage over the MUSE range. These band data appear consistent with ExoMOL ammonia line data of Yurchenko et al. (2011), at wavelengths where they overlap, but these latter data do not cover the ammonia absorption bands at 0.79 and 0.765 μm, which are prominent in our MUSE observations. However, we find the band data of Bowles et al. (2008) are not reliable at wavelengths less than 0.758 μm. At shorter wavelengths we find the laboratory observations of Lutz and Owen (1980) provide a good indication of the position and shape of the ammonia absorptions near 0.552 μm and 0.648 μm, but their absorption strengths appear inconsistent with the band data of Bowles et al. (2008) at longer wavelengths. Finally, we find that the line data of the 0.648 μm absorption band of Giver et al. (1975) are not suitable for modelling these data as they account for only 17% of the band absorption and cannot be extended reliably to the cold temperatures and H2/He-broadening conditions found in Jupiter’s atmosphere. This work is of significance not only for solar system planetary physics, but also for future proposed observations of Jupiter-like planets orbiting other stars, such as with NASA’s planned Wide-Field Infrared Survey Telescope (WFIRST)

Analysis of gaseous ammonia (NH3) absorption in the visible spectrum of Jupiter - Update

An analysis of currently available ammonia (NH3) visible-to-near-infrared gas absorption data was recently undertaken by Irwin et al. (2018) to help interpret Very Large Telescope (VLT) MUSE observations of Jupiter from 0.48–0.93 µm, made in support of the NASA/Juno mission. Since this analysis a newly revised set of ammonia line data, covering the previously poorly constrained range 0.5–0.833 µm, has been released by the ExoMol project, “C2018” (Coles et al., 2018), which demonstrates significant advantages over previously available data sets, and provides for the first time complete line data for the previously poorly constrained 5520- and 6475-Å bands of NH3. In this paper we compare spectra calculated using the ExoMol–C2018 data set (Coles et al., 2018) with spectra calculated from previous sources to demonstrate its advantages. We conclude that at the present time the ExoMol–C2018 dataset provides the most reliable ammonia absorption source for analysing low- to medium-resolution spectra of Jupiter in the visible/near-IR spectral range, but note that the data are less able to model high-resolution spectra owing to small, but significant inaccuracies in the line wavenumber estimates. This work is of significance not only for solar system planetary physics, but for future proposed observations of Jupiter-like planets orbiting other stars, such as with NASA’s planned Wide-Field Infrared Survey Telescope (WFIRST)

Analysis of gaseous ammonia (NH3) absorption in the visible spectrum of Jupiter - Update

An analysis of currently available ammonia (NH3) visible-to-near-infrared gas absorption data was recently undertaken by Irwin et al. (2018) to help interpret Very Large Telescope (VLT) MUSE observations of Jupiter from 0.48–0.93 µm, made in support of the NASA/Juno mission. Since this analysis a newly revised set of ammonia line data, covering the previously poorly constrained range 0.5–0.833 µm, has been released by the ExoMol project, “C2018” (Coles et al., 2018), which demonstrates significant advantages over previously available data sets, and provides for the first time complete line data for the previously poorly constrained 5520- and 6475-Å bands of NH3. In this paper we compare spectra calculated using the ExoMol–C2018 data set (Coles et al., 2018) with spectra calculated from previous sources to demonstrate its advantages. We conclude that at the present time the ExoMol–C2018 dataset provides the most reliable ammonia absorption source for analysing low- to medium-resolution spectra of Jupiter in the visible/near-IR spectral range, but note that the data are less able to model high-resolution spectra owing to small, but significant inaccuracies in the line wavenumber estimates. This work is of significance not only for solar system planetary physics, but for future proposed observations of Jupiter-like planets orbiting other stars, such as with NASA’s planned Wide-Field Infrared Survey Telescope (WFIRST)

Analysis of gaseous ammonia (NH3) absorption in the visible spectrum of Jupiter - Update

An analysis of currently available ammonia (NH3) visible-to-near-infrared gas absorption data was recently undertaken by Irwin et al. (2018) to help interpret Very Large Telescope (VLT) MUSE observations of Jupiter from 0.48–0.93 µm, made in support of the NASA/Juno mission. Since this analysis a newly revised set of ammonia line data, covering the previously poorly constrained range 0.5–0.833 µm, has been released by the ExoMol project, “C2018” (Coles et al., 2018), which demonstrates significant advantages over previously available data sets, and provides for the first time complete line data for the previously poorly constrained 5520- and 6475-Å bands of NH3. In this paper we compare spectra calculated using the ExoMol–C2018 data set (Coles et al., 2018) with spectra calculated from previous sources to demonstrate its advantages. We conclude that at the present time the ExoMol–C2018 dataset provides the most reliable ammonia absorption source for analysing low- to medium-resolution spectra of Jupiter in the visible/near-IR spectral range, but note that the data are less able to model high-resolution spectra owing to small, but significant inaccuracies in the line wavenumber estimates. This work is of significance not only for solar system planetary physics, but for future proposed observations of Jupiter-like planets orbiting other stars, such as with NASA’s planned Wide-Field Infrared Survey Telescope (WFIRST)

Color and aerosol changes in Jupiter after a North Temperate Belt disturbance

The banded appearance of Jupiter’s atmosphere shows significant changes over time, sometimes even transforming the reflectivity of a whole latitudinal band in a few weeks, and staying for years with an aspect different from the usual one. The origin of some of these disturbances may be associated with the creation and destruction of the chromophore species that provides Jovian clouds their reddish coloration. In this work, we have focused on the North Temperate Belt (NTB) disturbance detected during the second flyby of Juno mission (NASA) on October 2016, as a series of convective storms interacted with the fastest zonal jet on Jupiter at 24N over months and left a quiet belt characterized by an intense red coloration Sánchez-Lavega et al. (2017). In order to determine the corresponding changes in the upper clouds and hazes we have used images taken in 2016 and 2017 with the Hubble Space Telescope Wide Field Camera 3. Such images were acquired before and after the outbreak, showing an intense color change in a narrow latitude band. The images cover the wavelength range from 250 nm up to the methane absorption band at 890 nm, thus sensitive to a number of atmospheric levels from the lower stratosphere to the upper troposphere where the ammonia condensation cloud is expected to be located. Here we use the radiative transfer suite NEMESIS Irwin et al. (2008) to determine the vertical distribution and properties of the upper hazes that best match the observed dependence of reflectivity with wavelength and geometry. We use two models for the Jovian chromophore: (A) an extended layer whose imaginary refractive index is left as a free parameter; and (B) a concentrated chromophore as in Sromovsky et al. (2017) using the optical properties by Carlson et al. (2016). Both scenarios show an increase in the number of particles responsible for the blue absorption approximately by a factor of 2, and require only small changes in the rest of the atmospheric parameters. We find that, even though results provided by scenario B are also compatible with observations, the limb-darkening is better described by scenario A, where there is also an increase of the particle absorption at the shortest wavelengths. In this work, we also provide an extension of the expected imaginary refractive indices to wavelengths beyond those covered in previous laboratory works, which will be useful for future studies

Upper limits for phosphine (PH3) in the atmosphere of Mars

Phosphine (PH3) is proposed to be a possible biomarker in planetary atmospheres and has been claimed to have been observed in the atmosphere of Venus, sparking interest in the habitability of Venus’s atmosphere. Observations of another biomarker, methane (CH4), have been reported several times in the atmosphere of Mars, hinting at the possibility of a past or present biosphere. The Atmospheric Chemistry Suite on the ExoMars Trace Gas Orbiter has a spectral range that includes several absorption lines of PH3 with line strengths comparable to previously observed CH4 lines. The signature of PH3 was not observed in the 192 observations made over a full Martian year of observations, and here we report upper limits of 0.1–0.6 ppbv