Clinical use of fungal PCR from deep tissue samples in the diagnosis of invasive fungal diseases : a retrospective observational study

Objectives: To assess the clinical use of panfungal PCR for diagnosis of invasive fungal diseases (IFDs). We focused on the deep tissue samples. Methods: We first described the design of panfungal PCR, which is in clinical use at Helsinki University Hospital. Next we retrospectively evaluated the results of 307 fungal PCR tests performed from 2013 to 2015. Samples were taken from normally sterile tissues and fluids. The patient population was nonselected. We classified the likelihood of IFD according to the criteria of the European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG), comparing the fungal PCR results to the likelihood of IFD along with culture and microscopy results. Results: There were 48 positive (16%) and 259 negative (84%) PCR results. The sensitivity and specificity of PCR for diagnosing IFDs were 60.5% and 91.7%, respectively, while the negative predictive value and positive predictive value were 93.4% and 54.2%, respectively. The concordance between the PCR and the culture results was 86% and 87% between PCR and microscopy, respectively. Of the 48 patients with positive PCR results, 23 had a proven or probable IFD. Conclusions: Fungal PCR can be useful for diagnosing IFDs in deep tissue samples. It is beneficial to combine fungal PCR with culture and microscopy. M. Ala-Houhala, Clin Microbiol Infect 2018;24:301 (C) 2017 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.Peer reviewe

Left Ventricular Hypertrophy is a predictor of cardiovascular events in elderly hypertensives: hypertension in the the very elderly trial (HYVET)

Objective: We assessed the prognostic value of electrocardiographic left ventricular hypertrophy (LVH) using Sokolow-Lyon (SL-LVH), Cornell Voltage (CV-LVH) or Cornell Product (CP-LVH) Criteria in 3043 hypertensive people aged 80 years and over enrolled in the Hypertension in the Very Elderly Trial. Methods: Multivariate Cox proportional hazard models were used to estimate hazard ratios (HR) with 95% confidence intervals (CI) for all-cause mortality, cardiovascular diseases, stroke and heart failure in participants with and without LVH at baseline. The mean follow-up was 2.1 years. Results: LVH identified by CV- or CP-LVH Criteria was associated with a 1.6 to 1.9-fold risk of cardiovascular disease and stroke. The presence of CP-LVH was associated with an increased risk of heart failure (HR 2.38, 95% CL 1.16-4.86). In gender specific analyses, CV-LVH (HR 1.94, 95%Cl 1.06-3.55) and CP-LVH (HR 2.36, 95% CI 1.25-4.45) were associated with an increased risk of stroke in women and of heart failure in men, CV-LVH (HR 6.47, 95 % Cl 1.41-29.79) and CP-LVH (10.63, 95Cl % 3.58-31.57), respectively. There was no significant increase in the risk of any outcomes associated with SL LVH. LVH identified by these three methods was not a significant predictor of all-cause mortality. Conclusions: Use of Cornell Voltage and Cornell Product criteria for LVH predicted the risk of cardiovascular disease and stroke. Only Cornell Product was associated with an increased the risk of heart failure. This was particularly the case in men. The identification of electrocardiographic LVH proved to be important in very elderly hypertensive people

Prospective study of pathogens in asymptomatic travellers and those with diarrhoea : aetiological agents revisited

Travellers' diarrhoea (TD) remains the most frequent health problem encountered by visitors to the (sub) tropics. Traditional stool culture identifies the pathogen in only 15% of cases. Exploiting PCR-based methods, we investigated TD pathogens with a focus on asymptomatic travellers and severity of symptoms. Pre- and post-travel stools of 382 travellers with no history of antibiotic use during travel were analysed with a multiplex quantitative PCR for Salmonella, Yersinia, Campylobacter, Shigella, Vibrio cholerae and five diarrhoeagenic Escherichia coli: enteroaggregative (EAEC), enteropathogenic (EPEC), enterotoxigenic (ETEC), enterohaemorrhagic (EHEC) and enteroinvasive (EIEC). The participants were categorized by presence/absence of TD during travel and on return, and by severity of symptoms. A pathogen was indentified in 61% of the asymptomatic travellers, 83% of those with resolved TD, and 83% of those with ongoing TD; 25%, 43% and 53% had multiple pathogens, respectively. EPEC, EAEC, ETEC and Campylobacter associated especially with ongoing TD symptoms. EAEC and EPEC proved more common than ETEC. To conclude, modern methodology challenges our perception of stool pathogens: all pathogens were common both in asymptomatic and symptomatic travellers. TD has a multibacterial nature, but diarrhoeal symptoms mostly associate with EAEC, EPEC, ETEC and Campylobacter. (C) 2016 The Authors. Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.Peer reviewe

Integrating dispersal proxies in ecological and environmental research in the freshwater realm

Dispersal is one of the key mechanisms affecting the distribution of individuals, populations, and communities in nature. Despite advances in the study of single species, it has been notoriously difficult to account for dispersal in multispecies metacommunities, where it potentially has strong effects on community structure beyond those of local environmental conditions. Dispersal should thus be directly integrated in both basic and applied research by using proxies. Here, we review the use of proxies in the current metacommunity research, suggest new proxies, and discuss how proxies could be used in community modelling, particularly in freshwater systems. We suggest that while traditional proxies may still be useful, proxies formerly utilized in transport geography may provide useful novel insights into the structuring of biological communities in freshwater systems. We also suggest that understanding the utility of such proxies for dispersal in metacommunities is highly important for many applied fields such as freshwater bioassessment, conservation planning, and recolonization research in the context of restoration ecology. These research fields have often ignored spatial dynamics and focused mostly on local environmental conditions and changes therein. Yet, the conclusions of these applied studies may change considerably if dispersal is taken into account

Pursuing concordance: moving away from paternalism

In the second of two articles exploring the value and application of concordance across nursing practice the discussion is aimed at clinical settings and patient groups where concordance may have been viewed as impractical. The author harnesses Cribb and Entwhistle's broader conception of shared decision making and the notion of decision-making capacity as a continuum to argue that concordance can be pursued effectively in challenging settings such as childcare practice, mental health and the care of older people. As in the first paper (McKinnon, 2013) the discussion is not limited to medicines management but remains engaged with all aspects of nursing practice. Legal and ethical frameworks, social participation theory and research across healthcare practice are sourced to argue for concordant approaches in the care of patients who may at times have compromised decision-making capacity. Ideas of direct and indirect concordance are explored. © 2014 MA Healthcare Ltd

Antihypertensive treatment decreases arterial stiffness at night but not during the day. Results from the Hypertension in the Very Elderly Trial

The main Hypertension in the Very Elderly Trial (HYVET) demonstrated a very marked reduction in cardiovascular events by treating hypertensive participants 80 years or older with a low dose, sustained release prescription of indapamide (indapamide SR, 1.5 mg) to which was added a low dose of an angiotensin converting enzyme inhibitor in two-thirds of cases (perindopril 2–4 mg). This report from the ambulatory blood pressure sub-study investigates whether changes in arterial stiffness and ambulatory blood pressure (BP) could both explain the benefits observed in the main trial. A total of 139 participants were randomized to placebo [67] and to active treatment [72] and had both day and night observations of BP and arterial stiffness as determined from the Q wave Korotkoff diastolic (QKD) interval. The QKD interval was 5.6 ms longer (p = 0.017) in the actively treated group at night than in the placebo group. This was not true for the more numerous daytime readings so that 24-h results were similar in the two groups. The QKD interval remained longer at night in the actively treated group even when adjusted for systolic pressure, heart rate and height. The reduced arterial stiffness at night may partly explain the marked benefits observed in the main trial

Response to HYVET ambulatory blood pressure substudy

status: publishe

Association Between Cognition, Health Related Quality of Life, and Costs in a Population at Risk for Cognitive Decline

Background: The association between health-related quality of life (HRQoL) and care costs in people at risk for cognitive decline is not well understood. Studying this association could reveal the potential benefits of increasing HRQoL and reducing care costs by improving cognition. Objective: In this exploratory data analysis we investigated the association between cognition, HRQoL utilities and costs in a well-functioning population at risk for cognitive decline. Methods: An exploratory data analysis was conducted using longitudinal 2-year data from the FINGER study (n= 1,120). A change score analysis was applied using HRQoL utilities and total medical care costs as outcome. HRQoL utilities were derived from the Short Form Health Survey-36 (SF-36). Total care costs comprised visits to a general practitioner, medical specialist, nurse, and days at hospital. Analyses were adjusted for activities of daily living (ADL) and depressive symptoms. Results: Although univariable analysis showed an association between cognition and HRQoL utilities, multivariable analysis showed no association between cognition, HRQoL utilities and total care costs. A one-unit increase in ADL limitations was associated with a -0.006 (p Conclusion: The level of cognition in people at-risk for cognitive decline does not seem to be associated with HRQoL utilities. Future research should examine the level at which cognitive decline starts to affect HRQoL and care costs. Ideally, this would be done by means of cross-validation in populations with various stages of cognitive functioning and decline.Peer reviewe

Learning through the ages? Generational inequalities and inter-generational dynamics of lifelong learning

This exploratory paper considers the concept of generation in the context of learning across the life course. Although researchers have often found considerable inequalities in participation by age, as well as strongly articulated attitudinal differences, there have so far been only a handful of studies that have explored these patterns through the perspective of generational formations. The paper is primarily conceptual, exploratory and reflective, setting out a number of approaches to the concept of generations, most of which derive largely from debates with the ghost of Karl Mannheim; it then considers how these concepts of generation have been applied to understandings of educational inequalities in recent research in Germany and the Nordic nations. It then examines the dynamics of inter-generational relations in learning, drawing on research undertaken as part of the Teaching and Learning Research Programme. The paper argues that although inter-generational dynamics are a relatively neglected dimension of Anglophone research on life chances and learning, there is a strong case for understanding their dual roles in both inequality and cohesion. It concludes by outlining some themes and areas for further investigation in the future

Orthostatic hypotension and symptomatic subclinical orthostatic hypotension increase risk of cognitive impairment: an integrated evidence review and analysis of a large older adult hypertensive cohort.

Aims: Systematically reviewing the literature found orthostatic hypotension (OH) to be associated with an increased risk of incident dementia but limited data were available in those at highest risk, the hypertensive oldest-old. Our aim was to analyse the relationship between OH and incident cognitive decline or dementia in this group and to synthesize the evidence base overall. Method and results: Participants aged ≥80 years, with hypertension, were from the Hypertension in the Very Elderly Trial (HYVET) cohort. Orthostatic hypotension was defined as a fall of ≥15 mmHg in systolic and or ≥7 mmHg in diastolic pressure after 2 min standing from a sitting position. Subclinical orthostatic hypotension with symptoms (SOH) was defined as a fall <OH but with unsteadiness, light-headedness, or faintness in the week before blood pressure measurement. Proportional hazard regression was used to examine the relationship between baseline OH, SOH, and cognitive outcomes. There were 3121 in the analytical sample, 538 with OH. Orthostatic hypotension was associated with increased risk of cognitive decline (906 events), hazard ratio (HR) 1.36 (95% confidence interval 1.14-1.59). For incident dementia (241 events), HR 1.34 (0.98-1.84). When competing risk of cardiovascular events were taken into account results were HR 1.39 (1.19-1.62) and HR 1.34 (1.05-1.73), respectively. Subclinical orthostatic hypotension was associated with an increased risk of cognitive decline HR 1.56 (1.12-2.17) and dementia HR 1.79 (1.00-3.20). Combining the results from the HYVET cohort in a meta-analysis with the existing published literature in this area found a 21% (9-35%) increased risk of dementia with OH. Conclusion: Orthostatic hypotension indicates an increased risk of dementia and cognitive decline. SOH may also be considered a risk factor, at least in older hypertensive adults. Questions remain regarding the mechanisms and whether interventions to reduce impact of OH could protect cognition