US Cystic Fibrosis Foundation and European Cystic Fibrosis Society consensus recommendations for the management of non-tuberculous mycobacteria in individuals with cystic fibrosis

Non-tuberculous mycobacteria (NTM) are ubiquitous environmental organisms that can cause chronic pulmonary infection, particularly in individuals with preexisting inflammatory lung disease such as cystic fibrosis(CF). Pulmonary disease caused by NTM has emerged as a major threat to the health of individuals with CF but remains difficult to diagnose and problematic to treat. In response to this challenge, the US Cystic Fibrosis Foundation (CFF) and the European Cystic Fibrosis Society (ECFS) convened an expert panel of specialists to develop consensus recommendations for the screening, investigation, diagnosis and management of NTM pulmonary disease in individuals with CF. Nineteen experts were invited to participate in the recommendation development process. Population, Intervention, Comparison, Outcome (PICO) methodology and systematic literature reviews were employed to inform draft recommendations. An anonymous voting process was used by the committee to reach consensus. All committee members were asked to rate each statement on a scale of: 0, completely disagree, to 9, completely agree; with 80% or more of scores between 7 and 9 being considered ‘good’ agreement. Additionally, the committee solicited feedback from the CF communities in the USA and Europe and considered the feedback in the development of the final recommendation statements. Three rounds of voting were conducted to achieve 80% consensus for each recommendation statement. Through this process, we have generated a series of pragmatic, evidence-based recommendations for the screening, investigation, diagnosis and treatment of NTM infection in individuals with CF as an initial step in optimising management for this challenging condition

Using Dried Blood Spots for a Sero-Surveillance Study of Maternally Derived Antibody against Group B Streptococcus

Vaccination during pregnancy could protect women and their infants from invasive Group B Streptococcus (GBS) disease. To understand if neonatal dried blood spots (DBS) can be used to determine the amount of maternally derived antibody that protects infants against invasive GBS disease, a retrospective case-control study was conducted in England between 1 April 2014 and 30 April 2015. The DBS of cases with invasive GBS disease (n = 61) were matched with healthy controls (n = 125). The haematocrit, DBS storage temperature, freeze-thaw cycle, and paired serum/DBS studies were set up to optimise the antibody assessment. The samples were analysed using a multiplex immunoassay, and the results were assessed using parametric and nonparametric tests. Antibody concentrations were stable at haematocrits of up to 50% but declined at 75%. DBS storage at room temperature was stable for three months compared with storage from collection at −20 °C and rapidly degraded thereafter. Total IgG levels measured in DBS and paired serum showed a good correlation (r2 = 0.99). However, due to suboptimal storage conditions, no difference was found in the GBS IgG levels between DBS samples from cases and controls. We have demonstrated a proof of concept that assays utilising DBS for assessing GBS serotype-specific antibodies in infants is viable. This method could be used to facilitate future large sero-correlate studies, but DBS samples must be stored at −20 °C for long term preservation of antibody

Hip Disarticulation for Severe Lower Extremity Infections

Hip disarticulation is rarely performed for infections and variable mortality rates have been reported. We determined the number of deaths following hip disarticulation for severe lower extremity infections in 15 patients. Indications for hip disarticulation were necrotizing soft tissue infections in seven patients and persistent infections of the proximal thigh in eight patients. The most common microorganism was Staphylococcus aureus, present in eight patients. Hip disarticulation was performed emergently in seven patients and electively in eight patients. All patients survived the operation and at 1 month postoperatively 14 of 15 patients were alive. Hip disarticulation for these severe infections had high survival, even when performed emergently for life-threatening infections. We believe hip disarticulation is a reasonable option treating severe infections of the lower extremity and should be part of the armamentarium of the orthopaedic surgeon

Methodology for Determining the Economic Development Impacts of Transit Projects

Transit Cooperative Research Program (TCRP) project H-39, “Methodology for Determining the Economic Development Impacts of Transit Projects,” was aimed at developing a method for transit agencies to assess whether and under what circumstances transit investments have economic benefits that are in addition to land development stimulated by travel time savings. It addresses the productivity increases associated with agglomeration economies—economies of scale in density—that may be caused by transit improvements. The authors reviewed existing evaluation practices and academic research, and then carried out a wide-ranging empirical study on metropolitan-level data from cities across the U.S., firm-level data from two metropolitan areas, and case studies of three recent transit projects. A spreadsheet tool was produced that could be used by transit agencies and others to estimate the agglomeration-related economic benefits of rail investments in the forms of new systems or additions to existing systems. With information about any of five possible measures of the proposed investment—track miles, total seating capacity, rail-specific seating capacity, rail revenue miles, or total revenue miles—the spreadsheet provides a range of possible wage or GDP impacts. The tool is best used to compare the agglomeration impacts of transit investments in different metropolitan areas to each other