Comparison of Binax NOW urine antigen test and pneumococcal DNA assay using qPCR before and after nasopharyngeal swabbing in healthy Malawian children.

Diagnosis of invasive pneumococcal disease is challenging. We compared Binax NOW pneumococcal urinary antigen test with blood pneumococcal PCR in healthy Malawian children with and without pneumococcal carriage, and we found a high false-positive rate with Binax NOW. Blood pneumococcal PCR positivity was 66/88 (75%) compared to 5/27 (18%) when nasopharyngeal swabbing was performed first compared to after blood sampling for pneumococcal blood PCR. We speculate that nasopharyngeal swabbing may be causing a breach of mucosal integrity, leading to invasion into the bloodstream. These findings need to be confirmed with autolysin-based PCR assays

Ability of quantitative PCR to discriminate Pneumocystis jirovecii pneumonia from colonization.

Introduction.Pneumocystis jirovecii pneumonia (PCP) is a severe disease affecting immunocompromised patients. Diagnosis is difficult due to the low sensitivity of direct examination and inability to grow the pathogen in culture. Quantitative PCR in bronchoalveolar lavage fluid (BAL) has high sensitivity, but limited specificity for distinguishing PCP from colonization.Aim. To assess the performance of an in-house quantitative PCR to discriminate between PCP and colonization.Methodology. This was a single-centre retrospective study including all patients with a positive PCR result for P. jirovecii in BAL between 2009 and 2017. Irrespective of PCR results, PCP was defined as the presence of host factors and clinical/radiological criteria consistent with PCP and (i) the presence of asci at direct examination of respiratory sample or (ii) anti-PCP treatment initiated with clinical response and absence of alternative diagnosis. Colonization was considered for cases who did not receive anti-PCP therapy with a favourable outcome or an alternative diagnosis. Cases who did not meet the above mentioned criteria were classified as 'undetermined'.Results. Seventy-one patients with positive P. jirovecii PCR were included (90 % non-HIV patients). Cases were classified as follows: 37 PCP, 22 colonization and 12 undetermined. Quantitative PCR values in BAL were significantly higher in patients with PCP versus colonization or undetermined (P<0.0001). The cut-off of 5×10 <sup>3</sup> copies/ml was able to discriminate PCP cases from colonization with 97 % sensitivity, 82 % specificity, 90 % positive predictive value and 95 % negative predictive value.Conclusions. Our quantitative PCR for P. jirovecii in BAL was reliable to distinguish PCP cases from colonization in this predominantly non-HIV population

Transfer Functions of Infinite-Dimensional Systems: Positive Realness and Stabilization

We consider a general class of operator-valued irrational positive-real functions with an emphasis on their frequency-domain properties and the relation with stabilization by output feedback. Such functions arise naturally as the transfer functions of numerous infinite-dimensional control systems, including examples specified by PDEs. Our results include characterizations of positive realness in terms of imaginary axis conditions, as well as characterizations in terms of stabilizing output feedback, where both static and dynamic output feedback are considered. In particular, it is shown that stabilizability by all static output feedback operators belonging to a sector can be characterized in terms of a natural positive-real condition and, furthermore, we derive a characterization of positive realness in terms of a mixture of imaginary axis and stabilization conditions. Finally, we introduce concepts of strict and strong positive realness, prove results which relate these notions and analyse the relationship between the strong positive realness property and stabilization by feedback. The theory is illustrated by examples, some arising from controlled and observed partial differential equations

A role for human leucocyte antigens in the susceptibility to SARS‐Cov‐2 infection observed in transplant patients

We analysed data from 80 patients who tested positive for SARS‐CoV‐2 RNA who had previously been HLA typed to support transplantation. Data were combined from two adjacent centres in Manchester and Leeds to achieve a sufficient number for early analysis. HLA frequencies observed were compared against two control populations: first, against published frequencies in a UK deceased donor population (n = 10,000) representing the target population of the virus, and second, using a cohort of individuals from the combined transplant waiting lists of both centres (n = 308), representing a comparator group of unaffected individuals of the same demographic. We report a significant HLA association with HLA‐ DQB1*06 (53% vs. 36%; p < .012; OR 1.96; 95% CI 1.94–3.22) and infection. A bias towards an increased representation of HLA‐A*26, HLA‐DRB1*15, HLA‐DRB1*10 and DRB1*11 was also noted but these were either only significant using the UK donor controls, or did not remain significant after correction for multiple tests. Likewise, HLA‐A*02, HLA‐B*44 and HLA‐C*05 may exert a protective effect, but these associations did not remain significant after correction for multiple tests. This is relevant information for the clinical management of patients in the setting of the current SARS‐CoV‐2 pandemic and potentially in risk‐assessing staff interactions with infected patients

Radiation-grafted membranes based on polyethylene for direct methanol fuel cells

Styrenewas grafted onto ultrahigh molecularweight polyethylene powder (UHMWPE) by gammairradiation using a 60Co source. Compression moulded films of selected pre-irradiated styrene-grafted ultrahigh molecular weight polyethylene (UHMWPE-g-PS) were post-sulfonated to the sulfonic acid derivative (UHMWPE-g-PSSA) for use as proton exchange membranes (PEMs). The sulfonation was confirmed by Xray photoelectron spectroscopy (XPS). The melting and flow properties of UHMWPE and UHMWPE-g-PS are conducive to forming homogeneous pore-free membranes. Both the ion conductivity and methanol permeability coefficient increased with degree of grafting, but the grafted membranes showed comparable or higher ion conductivity and lower methanol permeability than Nafion\uae 117 membrane. One UHMWPE-g-PS membrane was fabricated into a membrane\u2013electrode assembly (MEA) and tested as a single cell direct methanol fuel cell (DMFC). Low membrane cost and acceptable fuel cell performance indicate that UHMWPE-g-PSSA membranes could offer an alternative approach to perfluorosulfonic acidtype membranes for DMFC.Peer reviewed: YesNRC publication: Ye

The Diagnostic and Prognostic Accuracy of Five Markers of Serious Bacterial Infection in Malawian Children with Signs of Severe Infection

Early recognition and prompt and appropriate antibiotic treatment can significantly reduce mortality from serious bacterial infections (SBI). The aim of this study was to evaluate the utility of five markers of infection: C-reactive protein (CRP), procalcitonin (PCT), soluble triggering receptor expressed on myeloid cells-1 (sTREM-1), CD163 and high mobility group box-1 (HMGB1), as markers of SBI in severely ill Malawian children.Children presenting with a signs of meningitis (n = 282) or pneumonia (n = 95), were prospectively recruited. Plasma samples were taken on admission for CRP, PCT, sTREM-1 CD163 and HMGB1 and the performance characteristics of each test to diagnose SBI and to predict mortality were determined. Of 377 children, 279 (74%) had SBI and 83 (22%) died. Plasma CRP, PCT, CD163 and HMGB1 and were higher in HIV-infected children than in HIV-uninfected children (p<0.01). In HIV-infected children, CRP and PCT were higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and PCT and CD163 were higher in non-survivors (p = 0.001, p = 0.05 respectively). In HIV-uninfected children, CRP and PCT were also higher in children with SBI compared to those with no detectable bacterial infection (p<0.0005), and CD163 was higher in non-survivors (p = 0.05). The best predictors of SBI were CRP and PCT, and areas under the curve (AUCs) were 0.81 (95% CI 0.73–0.89) and 0.86 (95% CI 0.79–0.92) respectively. The best marker for predicting death was PCT, AUC 0.61 (95% CI 0.50–0.71).Admission PCT and CRP are useful markers of invasive bacterial infection in severely ill African children. The study of these markers using rapid tests in a less selected cohort would be important in this setting

Surface-modified polysulfone membranes: aqueous phase oxidation via persulfate radical

Peer reviewed: YesNRC publication: Ye

Driving pro-environmental change in tourist destinations: encouraging sustainable travel in National Parks via partnership project creation and implementation

© 2016 Taylor & Francis. This paper explores a key challenge in introducing more sustainable transport practices at destinations: achieving modal shift in visitor travel from cars to physically active or public transport to reduce tourism's environmental impacts. It centres on using partnership led projects bringing together the many public and private sector organisations involved, to drive destination change and development. To date, research has centred on pro-environmental change for individuals and individual organisations: little is known about the mechanisms of pro-environmental change via complex multi-partner organisations. The paper reports research into the processes involved in successful projects to provide alternatives to car travel in three UK National Parks by using partnerships to obtain funding and implement change. Based on case studies informed by in-depth interviews with key stakeholders involved in pro-environmental change implementation, narratives are analysed to explain the change process, and mapped against existing literature and theories of change. Conclusions show the role of inspired individuals, supportive senior management, strong governance, better visitor experiences and, most significantly, communication and communication of the benefits of change to stakeholders. The research suggests why and how change occurs in partnerships, contributes to better theories of change and offers guidance on understanding and implementing change processes worldwide

Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: Data linkage study of 11 million Australians

Objective To assess the cancer risk in children and adolescents following exposure to low dose ionising radiation from diagnostic computed tomography (CT) scans. Design Population based, cohort, data linkage study in Australia. Cohort members 10.9 million people identified from Australian Medicare records, aged 0-19 years on 1 January 1985 or born between 1 January 1985 and 31 December 2005; all exposures to CT scans funded by Medicare during 1985-2005 were identified for this cohort. Cancers diagnosed in cohort members up to 31 December 2007 were obtained through linkage to national cancer records. Main outcome Cancer incidence rates in individuals exposed to a CT scan more than one year before any cancer diagnosis, compared with cancer incidence rates in unexposed individuals. Results 60 674 cancers were recorded, including 3150 in 680 211 people exposed to a CT scan at least one year before any cancer diagnosis. The mean duration of follow-up after exposure was 9.5 years. Overall cancer incidence was 24% greater for exposed than for unexposed people, after accounting for age, sex, and year of birth (incidence rate ratio (IRR) 1.24 (95% confidence interval 1.20 to 1.29); P<0.001). We saw a dose-response relation, and the IRR increased by 0.16 (0.13 to 0.19) for each additional CT scan. The IRR was greater after exposure at younger ages (P<0.001 for trend). At 1-4, 5-9, 10-14, and 15 or more years since first exposure, IRRs were 1.35 (1.25 to 1.45), 1.25 (1.17 to 1.34), 1.14 (1.06 to 1.22), and 1.24 (1.14 to 1.34), respectively. The IRR increased significantly for many types of solid cancer (digestive organs, melanoma, soft tissue, female genital, urinary tract, brain, and thyroid); leukaemia, myelodysplasia, and some other lymphoid cancers. There was an excess of 608 cancers in people exposed to CT scans (147 brain, 356 other solid, 48 leukaemia or myelodysplasia, and 57 other lymphoid). The absolute excess incidence rate for all cancers combined was 9.38 per 100 000 person years at risk, as of 31 December 2007. The average effective radiation dose per scan was estimated as 4.5 mSv. Conclusions The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose