Diagnostic probability classification in suspected borreliosis by a novel Borrelia C6-peptide IgG1- subclass antibody test

The tick-borne multisystemic infection caused by Borrelia burgdorferi sensu lato, Lyme borreliosis, or Lyme disease, occurring in temperate regions of the northern hemisphere, continues to spread geographically with the expanding tick population. Despite the rising perceived risk of infection in the population, the clinical diagnosis of Borrelia infection is not always obvious and the most important laboratory test, antibody detection, has limited accuracy in diagnosing active disease. According to international guidelines, the primary serology test, which has a high sensitivity-low specificity, should, be verified using a high specificity confirmation test to improve the specificity. However, this enhancement in specificity comes at the cost of lower sensitivity. This two-step procedure is often omitted in everyday clinical practice. An optimal primary test would be one where no secondary tests for confirmation would be necessary. In the present study, the performance of a novel assay for quantitating IgG1-subclass antibodies to Borrelia C6-peptide was compared to a commercial reference assay of total IgG and IgM antibodies to Borrelia C6-peptide in the setting of a high endemic area for borreliosis. A derivation study on a retrospective clinical material was performed to compare the performance parameters and assess the discriminatory properties of the assays, followed by a prospective validation study. The IgG1-antibody assay achieved comparable summary performance parameters to those of the reference assay. The sensitivity was almost 100% while the specificity was about 50%. In a high-endemic setting, characterized by high background seropositivity of about 50% and disease prevalence of approximately 10%, antibody tests are unable to rule-in active Borrelia infection. The rule-out assessment of the methods revealed that of 1000 patients, 7 – 54 with negative results based on the reference method could have an active Borrelia infection. Such uncertainty was not found for the index test and may help improve the risk classification of patients

Reactivation and immunological studies on a japanese variant of red cell carbonic anhydrase I, CA I hiroshima-1

1. 1. Under certain conditions, CA I HIR-1++ (86 Asp--> Gly) was inactivated in Gnd-HCl more rapidly than normal CA I.2. 2. After denaturation in 5.0 M Gnd [middle dot] HC1, CA I HIR-1 was reactivated more slowly than normal CA I.3. 3. CA I HIR-1 was precipitated by purified anti-CA I antibodies, under certain conditions, more rapidly than normal CA I.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/24126/1/0000383.pd

Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory

This document is the Accepted Manuscript version of the following article: Paul M. Jenkinson, Lauren Taylor, Keith R. Laws, ‘Self-reported interoceptive deficits in eating disorders: A meta-analysis of studies using the eating disorder inventory’, Journal of Psychosomatic Research, Vol. 110: 38-45, July 2018, under embargo until 19 April 2019. The Version of Record is available online at DOI: https://doi.org/10.1016/j.jpsychores.2018.04.005Objective: An impairment of the ability to sense the physiological condition of the body – interoception – has long been proposed as central to the onset and maintenance of eating disorders. More recent attention to this topic has generally indicated the presence of interoceptive deficits in individuals with an eating disorder diagnosis; however, possible links with specific diagnosis, BMI, age, illness duration, depression, and alexithymia remain unclear from individual studies. This meta-analysis aimed to provide a necessary quantitative overview of self-reported interoceptive deficits in eating disorder populations, and the relationship between these deficits and the previously mentioned factors. Methods: Using a random effects model, our meta-analysis assessed the magnitude of differences in interoceptive abilities as measured using the Eating Disorder Inventory in 41 samples comparing people with eating disorders (n=4308) and healthy controls (n=3459). Follow-up and moderator analysis was conducted, using group comparisons and meta-regressions. Results: We report a large pooled effect size of 1.62 for eating disorders with some variation between diagnostic groups. Further moderator analysis showed that BMI, age and alexithymia were significant predictors of overall effect size. Conclusion: This meta-analysis is the first to confirm that large interoceptive deficits occur in a variety of eating disorders and crucially, in those who have recovered. These deficits may be useful in identifying and distinguishing eating disorders. Future research needs to consider both objective and subjective measures of interoception across different types of eating disorders and may fruitfully examine interoception as a possible endophenotype and target for treatment.Peer reviewe

Structure of the icosahedral Ti-Zr-Ni quasicrystal

The atomic structure of the icosahedral Ti-Zr-Ni quasicrystal is determined by invoking similarities to periodic crystalline phases, diffraction data and the results from ab initio calculations. The structure is modeled by decorations of the canonical cell tiling geometry. The initial decoration model is based on the structure of the Frank-Kasper phase W-TiZrNi, the 1/1 approximant structure of the quasicrystal. The decoration model is optimized using a new method of structural analysis combining a least-squares refinement of diffraction data with results from ab initio calculations. The resulting structural model of icosahedral Ti-Zr-Ni is interpreted as a simple decoration rule and structural details are discussed.Comment: 12 pages, 8 figure

ALMA observations of <i>α</i> Centauri: first detection of main-sequence stars at 3 mm wavelength

Context. The precise mechanisms that provide the non-radiative energy for heating the chromosphere and the corona of the Sun and those of other stars constitute an active field of research. By studying stellar chromospheres one aims at identifying the relevant physical processes. Defining the permittable extent of the parameter space can also serve as a template for the Sun-as-a-star. This feedback will probably also help identify stars that potentially host planetary systems that are reminiscent of our own. Aims. Earlier observations with Herschel and APEX have revealed the temperature minimum of α Cen, but these were unable to spatially resolve the binary into individual components. With the data reported in this Letter, we aim at remedying this shortcoming. Furthermore, these earlier data were limited to the wavelength region between 100 and 870 μm. In the present context, we intend to extend the spectral mapping (SED) to longer wavelengths, where the contrast between stellar photospheric and chromospheric emission becomes increasingly evident. Methods. The Atacama Large Millimeter/submillimeter Array (ALMA) is particularly suited to point sources, such as unresolved stars. ALMA provides the means to achieve our objectives with both its high sensitivity of the collecting area for the detection of weak signals and the high spatial resolving power of its adaptable interferometer for imaging close multiple stars. Results. This is the first detection of main-sequence stars at a wavelength of 3 mm. Furthermore, the individual components of the binary α Cen AB are clearly detected and spatially well resolved at all ALMA wavelengths. The high signal-to-noise ratios of these data permit accurate determination of their relative flux ratios, i.e., SyB / SyA = 0.54 ± 0.04 at 440 μm, = 0.46 ± 0.01 at 870 μm, and = 0.47 ± 0.006 at 3.1 mm, respectively. Conclusions. The previously obtained flux ratio of 0.44±0.18, which was based on measurements in the optical and at 70 μm, is consistent with the present ALMA results, albeit with a large error bar. The observed 3.1 mm emission greatly exceeds what is predicted from the stellar photospheres, and undoubtedly arises predominantly as free-free emission in the ionized chromospheric plasmas of both stars. Given the distinct difference in their cyclic activity, the similarity of their submm SEDs appears surprising

Decreased Th1-Type Inflammatory Cytokine Expression in the Skin Is Associated with Persisting Symptoms after Treatment of Erythema Migrans

Background: Despite the good prognosis of erythema migrans (EM), some patients have persisting symptoms of various character and duration post-treatment. Several factors may affect the clinical outcome of EM, e. g. the early interaction between Borrelia (B.) burgdorferi and the host immune response, the B. burgdorferi genotype, antibiotic treatment as well as other clinical circumstances. Our study was designed to determine whether early cytokine expression in the skin and in peripheral blood in patients with EM is associated with the clinical outcome. Methods: A prospective follow-up study of 109 patients with EM was conducted at the A land Islands, Finland. Symptoms were evaluated at 3, 6, 12 and 24 months post-treatment. Skin biopsies from the EM and healthy skin were immunohistochemically analysed for expression of interleukin (IL)-4, IL-10, IL-12p70 and interferon (IFN)-gamma, as well as for B. burgdorferi DNA. Blood samples were analysed for B. burgdorferi antibodies, allergic predisposition and levels of systemic cytokines. Findings: None of the patients developed late manifestations of Lyme borreliosis. However, at the 6-month follow-up, 7 of 88 patients reported persisting symptoms of diverse character. Compared to asymptomatic patients, these 7 patients showed decreased expression of the Th1-associated cytokine IFN-gamma in the EM biopsies (p = 0.003). B. afzelii DNA was found in 48%, B. garinii in 15% and B. burgdorferi sensu stricto in 1% of the EM biopsies, and species distribution was the same in patients with and without post-treatment symptoms. The two groups did not differ regarding baseline patient characteristics, B. burgdorferi antibodies, allergic predisposition or systemic cytokine levels. Conclusion: Patients with persisting symptoms following an EM show a decreased Th1-type inflammatory response in infected skin early during the infection, which might reflect a dysregulation of the early immune response. This finding supports the importance of an early, local Th1-type response for optimal resolution of LB.Original Publication: Johanna Sjöwall, Linda Fryland, Marika Nordberg, Florence Sjögren, Ulf Garpmo, Christian Jansson, Sten-Anders Carlsson, Sven Bergstrom, Jan Ernerudh, Dag Nyman, Pia Forsberg and Christina Ekerfelt, Decreased Th1-Type Inflammatory Cytokine Expression in the Skin Is Associated with Persisting Symptoms after Treatment of Erythema Migrans, 2011, PLOS ONE, (6), 3, 0018220. http://dx.doi.org/10.1371/journal.pone.0018220 Copyright: Public Library of Science (PLoS) http://www.plos.org

Systematic review of behaviour change techniques to promote participation in physical activity among people with dementia

Purpose. The objective of this study was to systematically review the evidence for the potential promise of behaviour change techniques (BCTs) to increase physical activity among people with dementia (PWD). Methods. PsychINFO, MEDLINE, CINAHL, and the Cochrane Central Register of Controlled Trials databases were searched 01/01/2000 - 01/12/2016. Randomised controlled / quasi-randomised trials were included if they recruited people diagnosed / suspected to have dementia, used at least one BCT in the intervention arm, and had at least one follow-up measure of physical activity / adherence. Studies were appraised using the Cochrane Collaboration risk of bias tool, and BCTs were coded using Michie et al.’s (2013) taxonomy. Intervention findings were narratively synthesised as either ‘very promising’, ‘quite promising’, or ‘non-promising’, and BCTs were judged as having potential promise if they featured in at least twice as many very / quite promising than non-promising interventions (as per Gardner et al., 2016). Results. Nineteen articles from 9 trials reported physical activity findings on behavioural outcomes (2 very promising, 1 quite promising, and 2 non-promising) or intervention adherence (1 quite promising and 4 non-promising). Thirteen BCTs were used across the interventions. While no BCT had potential promise to increase intervention adherence, three BCTs had potential promise for improving physical activity behaviour outcomes: goal setting (behaviour), social support (unspecified), and using a credible source. Conclusions. Three BCTs have potential promise for use in future interventions to increase physical activity among PWD. PROSPERO registration number: 2015:CRD42015020219

The initiation of labour at term gestation: physiology and practice implications

Little is known about the physiology of labour onset at term, and there is a debate about what signs and symptoms should be used to define it. In low resource settings and, particularly, for remote and rural communities, delay in recognising labour onset may mean a delay in seeking a skilled birth attendant. This chapter presents the most recent evidence about the physiology of labour onset, including the complex neuro-hormonal, biophysical, psychological and emotional factors that contribute. The symptoms of labour onset are explored from the perspective of both pregnant women and service providers in a range of sociocultural contexts. Early labour presents challenges for pregnant women, their families, communities and health care professionals. The chapter discusses how maternity care services should be designed, and delivered to ensure that women get the optimum advice and care at the beginning of labour

Anorexia nervosa - The journey towards recovery : A randomized controlled treatment trial: assessment, prediction, treatment outcome and clinical change

The overall aim of this thesis was to study young adult women with anorexia nervosa (AN) participating in an randomized controlled trial in relation to assessment, treatment outcome, prediction, and clinical change.  The results confirm the Eating Disorder Inventory-3 as a valid instrument for measuring eating disorder symptoms and general psychopathology. AN patients, however, rate themselves significantly lower than patients with other eating disorder diagnoses, and interoceptive deficits are the best predictive subscale for AN diagnosis. Patients significantly improved in terms of weight and eating disorder psychopathology, with no differences between individual CBT and family therapy (FT). Most patients did not fulfill the diagnostic criteria at post-assessment, at 76% and 86% at followup. Patients in FT were considered completers to a higher extent than patients receiving CBT, and 8% were prematurely discharged, in comparison to 30% for CBT. Bulimic symptoms and emotional dysregulation at baseline had a negative effect on diagnostic symptoms, and lower levels of interoceptive deficits predicted weight increase in the FT group. Lower levels of emotional dysregulation and higher levels of interoceptive deficits explained 37% of the variance in BMI changes in the CBT group. The classifications of CS/RCI were shown to be valid when compared to normal controls. Patients classified as clinically significantly improved constituted 35-47% of all patients, and only three patients fulfilled the proposed definition of recovery. The agreement of the diagnostic criteria was fair. The results suggest that individual CBT and FT are effective treatments for young adults. The ability to acknowledge, interpret, and handle emotions is an important aspect of treatment. Self-report measurements are useful for evaluating individual changes; however, diagnostic criteria do not accord with self-reported symptom changes and physical, behavioral, and psychological measurements are important for a complete estimation of recovery

Outsourcing facilities services: needs and practices of Swedish owners of commercial property

Why and how facilities services are outsourced is a question that continues to attract interest. The purpose of this study has been to investigate links between categories of property owners and their demand for packaged facilities services. The empirical part is based on questionnaire responses from 20 large owners of commercial property in Sweden, and on interviews with 11 of these owners. Owners are characterized by portfolio value, geographical spread of properties, investment horizon, core business, and average tenant size. Three owner segments are identified and tentatively labelled Building Managers, Active Asset Managers, and Passive Asset Managers. Their outsourcing policies and practices differ clearly