Seasonal Variation in the Peritoneal Dialysis‐Related Infections: A Single Center Experience in the Mediterranean

Seasonal variation in the incidence of peritoneal dialysis‐related infections (PDRI) has been sparingly investigated, especially in the Mediterranean. Our aim was to explore this association in Malta. All PDRI occurring between Jan‐2008 and Dec‐2012 were retrospectively studied.A total of 137 patients were followed‐up for a median time of 32.5 months (range: 2‐81). During this time, 19% never had PDRI, 11.7% transferred permanently to hemodialysis and 6.6% received a kidney transplant. A total of 279 PDRI were identified, equating to 145 catheter‐related infections (CRI) and 144 peritonitis episodes (including 10 catheter related peritonitis). A spring peak in the overall gram positive PDRI (0.61 vs. 0.34/patient‐year‐at‐risk, P=0.05), together with a peak in gram negative peritonitis in the warm period (0.13 vs. 0.07/patient‐year at risk, P=0.04) was identified. The incidence rate ratios (Confidence Interval) involving the overall gram positive PDRI, gram positive peritonitis, coagulase‐negative Streptococci (CoNS) and Streptococci were 1.82 (1.18‐2.82, P=0.007), 2.20 (1.16‐4.16, P=0.02), 2.65 (1.17‐6.02, P=0.02] and 3.18 (1.03‐9.98, P=0.04) in spring when compared to winter. No significant difference in the overall PDRI, peritonitis or CRI rates between seasons or warm/cold period was identified.To our knowledge, this is the first study which examines the effect of seasons on the incidence of PDRI in the Mediterranean basin. Findings suggest that spring confers a higher risk for gram positive PDRIs, gram positive peritonitis, CoNS and Streptococcus, whilst the warm period was associated with a peak in the gram negative peritonitis.     

Experimental hepatic radiofrequency ablation using wet electrodes: electrode-to-vessel distance is a significant predictor for delayed portal vein thrombosis

The aim of this study was to examine possible explanatory variables associated with acute and delayed portal vein thrombosis after hepatic radiofrequency (RF) ablation using wet electrodes. Coagulations were created within 1.5 cm of the right portal vein (RPV) branch in 12 pigs with (n=6) or without (n=6) Pringle manoeuvre. Sham operations with Pringle manoeuvre were performed in four animals. Rotational portal venography was performed prior to ablation, 10 min after ablation and 4 days after ablation. Vessel diameters and vessel patency was determined from the portal venograms. Distance between the ablation electrode and RPV was measured from 3-dimensional reconstructions of the portal venograms. The portal veins were examined by microscopy. Delayed portal vein thrombosis was found in two of six animals in the Pringle group and three of six animals in the control group 4 days after ablation (P=1.0, Fisher’s exact test). All five occurrences of delayed portal vein thrombosis were found in the six animals with a distance between the ablation electrode and RPV of 5 mm or less (P=0.030), indicating that the electrode-to-vessel distance may be an independent explanatory factor for delayed portal vein thrombosis after RF ablation with wet electrodes.     

National and multinational guidelines in Europe: results from an online survey on awareness of different national and European psoriasis guidelines

Guidelines can be developed on a national or multinational level. There are discussions concerning the relevance of different guidelines at different regional levels. Guidelines’ evaluation can be approached by looking at the items “awareness”, “agreement”, “adoption” and “adherence”. To assess the awareness of national and European (EDF/EADV) guidelines as a means of guidelines’ evaluation. Online survey in five selected European countries (Germany [D], Spain [E], France [F], Italy [I], and the United Kingdom [UK]) among 257 dermatologists assessing awareness of different guidelines (European [EDF/EADV], German, Spanish, French, British). Participants were volunteers registered with a field market research company database. Mean awareness of EDF/EADV guidelines in all countries was 54 %, with lower results in the UK (33 %) and Germany (37 %) and higher awareness in Spain (63 %) and Italy (79 %). Awareness of the national guidelines was very high within the respective countries (mean 92 %). The European guidelines where always the best known guidelines after the respective national guidelines. The most important tools for dissemination of all guidelines were the original publication (63 %) and scientific presentations (46 %).This study identified widespread interest in guidelines as assessed by the grade of awareness. Awareness of European guidelines was higher in countries with late development of national guidelines (i.e. Spain and Italy) compared to countries with early development of own national guidelines such as Germany and the UK. National guidelines can reach almost complete awareness within their respective countries. The original publication is still the most important dissemination tool for guidelines.     

In vivo imaging of the 18-kDa translocator protein (TSPO) with [18F]FEDAA1106 and PET does not show increased binding in Alzheimer’s disease patients

Purpose

Imaging the 18-kDa translocator protein (TSPO) is considered a potential tool for in vivo evaluation of microglial activation and neuroinflammation in the early stages of Alzheimer’s disease (AD). ((R)-1-(2-chlorophenyl)-N-[¹¹C]-methyl-N-(1-methylpropyl)-3-isoquinoline caboxamide ([¹¹C]-(R)-PK11195) has been widely used for PET imaging of TSPO and, despite its low specific-to-nondisplaceable binding ratio, increased TSPO binding has been shown in AD patients. The high-affinity radioligand N-(5-fluoro-2-phenoxyphenyl)-N-(2-[¹⁸F]fluoroethyl-5-methoxybenzyl)acetamide ([¹⁸F]FEDAA1106) has been developed as a potential in vivo imaging tool for better quantification of TSPO binding. The aim of this study was to quantify in vivo binding of [¹⁸F]FEDAA1106 to TSPO in control subjects and AD patients.

Methods

Seven controls (five men, two women, age 68±3 years, MMSE score 29±1) and nine AD patients (six men, three women, age 69±4 years, MMSE score 25±3) were studied with [¹⁸F]FEDAA1106. PET measurements were performed on an ECAT EXACT HR system (Siemens Medical Solutions) in two 60-min dynamic PET sessions with a 30-min interval between sessions. Arterial blood radioactivity was measured using an automated blood sampling system for the first 5 min and using manually drawn samples thereafter. Quantification was performed using both kinetic analysis based on a two-tissue compartment model and Logan graphical analysis. Outcome measures were total distribution volume (V _T) and binding potential (BP _ND=k ₃/k ₄). An estimate of nondisplaceable distribution volume was obtained with the Logan graphical analysis using the first 15 min of PET measurements (V _{ND 1-15 min}). Binding potential (BP _ND) was also calculated as: V _T/V _{ND 1-15 min} ? 1.

Results

No statistically significant differences in V _T, k ₃/k ₄ or BP _ND were observed between controls and AD patients.

Conclusion

This study suggests that TSPO imaging with [¹⁸F]FEDAA1106 does not enable the detection of microglial activation in AD.     

Screened and unscreened hearing threshold levels for the adult population: Results from the Nord-Trøndelag Hearing Loss Study Niveles de umbrales auditivos tamizados y no tamizados en la población adulta. Resultados del estudio Nord-TrøndeIag sobre hipoacusias

This paper presents normative data of hearing threshold levels of a population screened with various criteria, as compared to unscreened population data. Computer-controlled pure-tone audiometry was administered to the adult population in Nord-Trøndelag County, Norway, during 1995–1997. The 51 975 participants also provided questionnaire information about occupational and leisure noise exposure, previous ear infections, and head injury. While screening had little effect on the median hearing threshold levels of young adults, there was a substantial effect when screening men above 40 years of age for a history of noise exposure. Screening for known ear-related disorders and diseases resulted in small effects on the mean hearing threshold levels. The median hearing thresholds of both the screened and the unscreened sample exceeded the age and sex specific thresholds specified by the ISO 7029.     

The “Path” Not Taken: Exploring Structural Differences in Mapped- Versus Shortest-Network-Path School Travel Routes

Objectives. School route measurement often involves estimating the shortest network path. We challenged the relatively uncritical adoption of this method in school travel research and tested the route discordance hypothesis that several types of difference exist between shortest network paths and reported school routes.Methods. We constructed the mapped and shortest path through network routes for a sample of 759 children aged 9 to 13 years in grades 5 and 6 (boys = 45%, girls = 54%, unreported gender = 1%), in Toronto, Ontario, Canada. We used Wilcoxon signed-rank tests to compare reported with shortest-path route measures including distance, route directness, intersection crossings, and route overlap. Measurement difference was explored by mode and location.Results. We found statistical evidence of route discordance for walkers and children who were driven and detected it more often for inner suburban cases. Evidence of route discordance varied by mode and school location.Conclusions. We found statistically significant differences for route structure and built environment variables measured along reported and geographic information systems–based shortest-path school routes. Uncertainty produced by the shortest-path approach challenges its conceptual and empirical validity in school travel research.Recent policy and research on children’s school travel has responded to reports of decadal declines in active school travel (AST)—that is, traveling to or from school under one’s own power, typically on foot or using a bicycle—in many Western nations.1–6 Evidence of a similar trend is also beginning to emerge in some cities in the global south.7 AST decline has been matched by increased prevalence of overweight and obesity in children and youths.8–10 Children driven to and from school and other activities miss transport-centered opportunities for physical activity and health benefits11–13 that, when combined with physical activity from other sources, could produce an active healthy lifestyle that may be sustained into adulthood.14–19 Understanding how to encourage AST could progress through development of valid evidence about the relationship between school travel route characteristics and travel mode choice.School travel research has often examined the relationship between travel mode choice and home, school, and route environments.20 Underpinning this work is the hypothesis that built environment (BE) features may enable or restrict household transport choices. A mix of BE effects, with some indication of difference by age, time of day, location (e.g., home, route, or school), and measurement approach (e.g., objective or subjective assessment), have been found.21–23 Studies of home, school, and travel mode without route information have suggested that both objective measures and perceptions of BE features and their use (i.e., traffic on busy roads) predict AST.21,23–25 Reported effects are not always in the same direction across studies. The odds of walking have been shown to increase with residential density in some studies but not in others.21,23,24 Marked differences in BE effects have also been reported when separate models are estimated for the morning and afternoon school travel periods.21 For example, and unique to their school-to-home model, Larsen et al.21 found that the effect of mixed land use (AST is more likely with mixed land use) intensified for the trip home; residential density became significant, along with income (i.e., AST is more likely in lower income neighborhoods); and a street tree effect (i.e., trees provide shade and are a direct and indirect measure of neighborhood aesthetics), significant in the morning model, was not reproduced.Route-based studies extend the home, school, and travel mode work by including BE features that children might experience along their route that could influence a household’s school travel decisions. For example, a child’s possible interaction with busy roads while walking to or from school could underlie a parent’s decision to drive. Route-based studies have typically involved measuring BE characteristics along and around assumed routes modeled using a geographic information systems (GIS)–based shortest-network-path algorithm.26–32 Although several diverse route effects have been reported, all studies have reproduced the finding that children are less likely to walk as route distance increases.26–32 Here again, different effects are reported for to- and from-school trips.26,27 For example, Larsen et al.26 reported significant effects for the presence of street trees, detached housing, and land use mix, that did not materialize in their school-to-home model. Findings regarding route directness, typically measured as the deviation of an assumed GIS-estimated route from the straight-line distance between home and school, have also been inconsistent. For adults, route directness is often associated with the use of active modes. In the school travel literature, the opposite effect,28,30 or no effect,26,27 has been found. Several studies have reported some relationship between major roads (crossed or along a route) and AST.26,28,30 Again, though, road-type effects may emerge for the school-to-home trip only26 or not at all.27 Child and parent self-report data have also indicated that a major road crossing may act as an AST barrier.31 Lastly, although land use mix appears to be associated with AST, in both route- and non–route-based studies25,26 scholars have appeared less certain about how land use in general (e.g., residential density, mix, street-facing windows) relates to or produces children’s transport. The literature presently projects the view that certain types of land use place some combination of more “eyes on the street” and more people (children and adults) in the street, thereby affecting adult risk perceptions regarding social fears and traffic.22,25 With the attenuation of adult risk perception, children may be more likely to engage in AST.22,25Notably, BE features that associate with school travel-mode choice seem to vary within and across studies set in different locations. Perhaps one of the problems is that, for route-based work in particular, the assumed GIS-based route is not an accurate approximation of the actual route traveled. The statistical validity of shortest-network-path route estimation is questionable; the method may not produce an accurate approximation of actual student travel routes. In this article, we challenge the relatively uncritical use of the GIS-based shortest-network-path approach often used to produce school travel routes (to and from) and route environments when observed or reported route data are absent. The research is organized around 1 question: Do quantifiable differences exist between mapped (reported) routes to and from school and school routes estimated using a GIS-based shortest-path algorithm? We addressed this question by testing the route discordance hypothesis that several types of difference exist between shortest-path route estimates and school routes mapped by child respondents.     

Validity and Reliability of Tools to Measure Muscle Mass,Strength, and Physical Performance in Community-Dwelling Older People: A Systematic Review

BackgroundThis study critically appraises the measurement properties of tools to measure muscle mass, strength, and physical performance in community-dwelling older people. This can support the selection of a valid and reliable set of tools that is feasible for future screening and identification of sarcopenia.MethodsThe databases PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Cochrane were systematically searched (January 11, 2012). Studies were included if they investigated the measurement properties or feasibility, or both, of tools to measure muscle mass, strength, and physical performance in community-dwelling older people aged ≥60 years. The consensus-based standards for the selection of health status measurement instruments (COSMIN) checklist was used for quality appraisal of the studies.ResultsSixty-two publications were deemed eligible, including tools for muscle mass (n = 16), muscle strength (n = 15), and physical performance (n = 31). Magnetic resonance imaging, computed tomography, and a 4-compartment model were used as gold standards for muscle mass assessment. Other frequently used measures of muscle mass are dual-energy x-ray and the bioelectrical impedance (BIA); however, reliability data of the BIA are lacking. Handheld dynamometry and gait speed or a short physical performance battery provide a valid and reliable measurement of muscle strength and physical performance, respectively.ConclusionsIt can be concluded that several tools are available for valid and reliable measurements of muscle mass, strength, and performance in clinical settings. For a home-setting BIA, handheld dynamometry and gait speed or a short physical performance battery are the most valid, reliable, and feasible. The combination of selected instruments and its use for the screening and identification of sarcopenia in community-dwelling older people need further evaluation.