Laboratory diagnosis of Lyme neuroborreliosis: a comparison of three CSF anti-Borrelia antibody assays

The diagnosis of Lyme neuroborreliosis (LNB) requires the detection of intrathecal synthesis of Borrelia-specific antibodies, but in very early disease, the sensitivity may be low. We compared the performance of the second-generation IDEIA Lyme Neuroborreliosis test (Oxoid), based on purified native flagellum antigen, with two newly developed tests based on several recombinant antigens for the diagnosis of LNB. Patients investigated for LNB during 2003 through 2007 were included (n = 175); 52 with definite LNB, four with possible LNB and 119 non-LNB patients. Serum and cerebrospinal fluid (CSF) were analysed with the IDEIA Lyme Neuroborreliosis (Oxoid), VIDAS Lyme IgG (bioMérieux) and recomBead Borrelia IgM and IgG (Mikrogen) assays. Intrathecal antibody indices (AIs) were calculated according to the manufacturers’ protocols. The IDEIA test performed with an overall sensitivity (IgM and IgG AIs taken together) of 88 % and a specificity of 99 %. The VIDAS test showed a sensitivity of 86 % and a specificity of 97 %. An overall sensitivity of 100 % and a specificity of 97 % were achieved by the recomBead test. We conclude that the three assays performed equally well regarding specificity, but our data suggest an improved diagnostic sensitivity with the recomBead Borrelia test

A recommendation to perform a blood culture before the administration of intravenous antibiotics increased the detection of Staphylococcus aureus bacteremia

In 2004, the Surviving Sepsis Campaign was launched to increase awareness and improve the outcome of severe sepsis. Accordingly, in Jönköping County, Sweden, a strong recommendation to perform a blood culture before the start of intravenous antibiotic treatment was introduced in 2007. Moreover, a reminder was included in the laboratory report to consult an infectious disease specialist when Staphylococcus aureus was isolated from a blood culture. Retrospectively, patients with at least one blood culture growing S. aureus during 2002 through 2003 (pre intervention n = 58) or during 2008 through 2009 (post intervention n = 100) were included. Medical records were evaluated regarding clinical data and outcome. Blood culture isolates were characterized by antibiotic susceptibility testing (AST) and S. aureus protein A (spa) gene typing. The annual incidence of S. aureus bacteremia (SAB) increased from 28 per 100,000 inhabitants at the pre intervention period to 45 per 100,000 at the post intervention period (p = 0.046). During post intervention, the SAB incidence was significantly higher in men (p = 0.009). The mortality rate during hospital stay was 14 % during pre intervention and 18 % during post intervention (p = 0.47). The most common spa types were t012 and t084. The Surviving Sepsis Campaign resulted in an increased number of detected cases of SAB. The mortality rate was the same before and after the intervention, and no spa type correlated to certain clinical manifestations or mortality

Analog Computer Research

Contains reports on three research projects

Aluminium and base cation chemistry in dynamic acidification models – need for a reappraisal?

Long-term simulations of the water composition in acid forest soils require that accurate descriptions of aluminium and base cation chemistry are used. Both weathering rates and soil nutrient availability depend on the concentrations of Al3+, of H+, and of base cations (Ca2+, Mg2+, Na+, and K+) . Assessments of the acidification status and base cation availability will depend on the model being used. Here we review in what ways different dynamic soil chemistry models describe the processes governing aluminium and base cation concentrations in the soil water. Furthermore, scenario simulations with the HD-MINTEQ model are used to illustrate the difference between model approaches. The results show that all investigated models provide the same type of response to changes in input water chemistry. Still, for base cations we show that the differences in the magnitude of the response may be considerable depending on whether a cation-exchange equation (Gaines–Thomas, Gapon) or an organic complexation model is used. The former approach, which is used in many currently used models (e.g. MAGIC, ForSAFE), causes stronger pH buffering over a relatively narrow pH range, as compared to state-of-the-art models relying on more advanced descriptions in which organic complexation is important (CHUM, HD-MINTEQ). As for aluminium, a fixed gibbsite constant, as used in MAGIC, SMART/VSD, and ForSAFE, leads to slightly more pH buffering than in the more advanced models that consider both organic complexation and Al(OH)3(s) precipitation, but in this case the effect is small. We conclude that the descriptions of acid–base chemistry and base cation binding in models such as MAGIC, SMART/VSD, and ForSAFE are only likely to work satisfactorily in a narrow pH range. If the pH varies greatly over time, the use of modern organic complexation models is preferred over cation-exchange equations.</p

Interprofessional education in a student-led emergency department : a realist evaluation

This paper reports a realist evaluation undertaken to identify factors that facilitated or hindered the successful implementation of interprofessional clinical training for undergraduate students in an emergency department. A realist evaluation provides a framework for understanding how the context and underlying mechanisms affect the outcome patterns of an intervention. The researchers gathered both qualitative and quantitative data from internal documents, semi-structured interviews, observations and questionnaires to study what worked, for whom and under what circumstances in this specific interprofessional setting. The study participants were medical, nursing and physiotherapy students, their supervisors and two members of the emergency department’s management staff. The data analysis indicated that the emergency ward provided an excellent environment for interprofessional education (IPE), as attested by the students, supervisors and the clinical managers. An essential prerequisite is that the students have obtained adequate skills to work independently. Exemplary conditions for IPE to work well in an emergency department demand the continuity of effective and encouraging supervision throughout the training period and supervisors who are knowledgeable about developing a team

Assessing the impact of acid rain and forest harvest intensity with the HD-MINTEQ model – soil chemistry of three Swedish conifer sites from 1880 to 2080

Forest soils are susceptible to anthropogenic acidification. In the past, acid rain was a major contributor to soil acidification, but, now that atmospheric levels of S have dramatically declined, concern has shifted towards biomass-induced acidification, i.e. decreasing soil solution pH due to tree growth and harvesting events that permanently remove base cations (BCs) from forest stands. We use a novel dynamic model, HD-MINTEQ (Husby Dynamic MINTEQ), to investigate possible long-term impacts of two theoretical future harvesting scenarios in the year 2020, a conventional harvest (CH, which removes stems only), and a whole-tree harvest (WTH, which removes 100&thinsp;% of the above-ground biomass except for stumps) on soil chemistry and weathering rates at three different Swedish forest sites (Aneboda, Gårdsjön, and Kindla). Furthermore, acidification following the harvesting events is compared to the historical acidification that took place during the 20th century due to acid rain. Our results show that historical acidification due to acid rain had a larger impact on pore water chemistry and mineral weathering than tree growth and harvesting, at least if nitrification remained at a low level. However, compared to a no-harvest baseline, WTH and CH significantly impacted soil chemistry. Directly after a harvesting event (CH or WTH), the soil solution pH sharply increased for 5 to 10 years before slowly declining over the remainder of the simulation (until year 2080). WTH acidified soils slightly more than CH, but in certain soil horizons there was practically no difference by the year 2080. Even though the pH in the WTH and CH scenario decreased with time as compared to the no-harvest scenario (NH), they did not drop to the levels observed around the peak of historic acidification (1980–1990), indicating that the pH decrease due to tree growth and harvesting would be less impactful than that of historic atmospheric acidification. Weathering rates differed across locations and horizons in response to historic acidification. In general, the predicted changes in weathering rates were very small, which can be explained by the net effect of decreased pH and increased Al3+, which affected the weathering rate in opposite ways. Similarly, weathering rates after the harvesting scenarios in 2020 remained largely unchanged according to the model.</p

Clinical and radiological evaluation of Trabecular Metal and the Smith–Robinson technique in anterior cervical fusion for degenerative disease: a prospective, randomized, controlled study with 2-year follow-up

A prospective, randomized, controlled study was carried out to compare the radiological and clinical outcomes after anterior cervical decompression and fusion (ACDF) with Trabecular Metal™ (TM) to the traditional Smith–Robinson (SR) procedure with autograft. The clinical results of cervical fusion with autograft from the iliac crest are typically satisfactory, but implications from the donor site are frequently reported. Alternative materials for cervical body interfusion have shown lower fusion rates. Trabecular Metal is a porous tantalum biomaterial with structure and mechanical properties similar to that of trabecular bone and with proven osteoconductivity. As much as 80 consecutive patients planned for ACDF were randomized for fusion with either TM or tricortical autograft from the iliac crest (SR) after discectomy and decompression. Digitized plain radiographic images of 78 (98%) patients were obtained preoperatively and at 2-year follow-up and were subsequently evaluated by two senior radiologists. Fusion/non-fusion was classified by visual evaluation of the A–P and lateral views in forced flexion/extension of the cervical spine and by measuring the mobility between the fused vertebrae. MRI of 20 TM cases at 2 years was successfully used to assess the decompression of the neural structures, but was not helpful in determining fusion/non-fusion. Pain intensity in the neck, arms and pelvis/hip were rated by patients on a visual analog scale (VAS) and neck function was rated using the Neck Disability Index (NDI) the day before surgery and 4, 12 and 24 months postoperatively. Follow-ups at 12 and 24 months were performed by an unbiased observer, when patients also assessed their global outcome. Fusion rate in the SR group was 92%, and in the TM group 69% (P < 0.05). The accuracy of the measurements was calculated to be 2.4°. Operating time was shorter for fusion with TM compared with autograft; mean times were 100 min (SD 18) and 123 min (SD 23), respectively (P = 0.001). The patients’ global assessments of their neck and arm symptoms 2 years postoperatively for the TM group were rated as 79% much better or better after fusion with TM and 75% using autograft. Pain scores and NDI scores were significantly improved in both groups when compared with baseline at all follow-ups, except for neck pain at 1 year for the TM group. There was no statistically significant difference in clinical outcomes between fusion techniques or between patients who appeared radiologically fused or non-fused. There was no difference in pelvic/hip pain between patients operated on with or without autograft. In our study, Trabecular Metal showed a lower fusion rate than the Smith–Robinson technique with autograft after single-level anterior cervical fusion without plating. There was no difference in clinical outcomes between the groups. The operative time was shorter with Trabecular Metal implants

Integrated information increases with fitness in the evolution of animats

One of the hallmarks of biological organisms is their ability to integrate disparate information sources to optimize their behavior in complex environments. How this capability can be quantified and related to the functional complexity of an organism remains a challenging problem, in particular since organismal functional complexity is not well-defined. We present here several candidate measures that quantify information and integration, and study their dependence on fitness as an artificial agent ("animat") evolves over thousands of generations to solve a navigation task in a simple, simulated environment. We compare the ability of these measures to predict high fitness with more conventional information-theoretic processing measures. As the animat adapts by increasing its "fit" to the world, information integration and processing increase commensurately along the evolutionary line of descent. We suggest that the correlation of fitness with information integration and with processing measures implies that high fitness requires both information processing as well as integration, but that information integration may be a better measure when the task requires memory. A correlation of measures of information integration (but also information processing) and fitness strongly suggests that these measures reflect the functional complexity of the animat, and that such measures can be used to quantify functional complexity even in the absence of fitness data.Comment: 27 pages, 8 figures, one supplementary figure. Three supplementary video files available on request. Version commensurate with published text in PLoS Comput. Bio