Berthelsenchandler5665

53 [95%CI 1.09-2.14]; male OR 1.42 [95%CI1.02-1.99]). Women diagnosed with vaginitis and cervicitis had higher prevalence of M. genitalium than women without those diagnoses, although this was statistically significant only for vaginitis (vaginitis OR 1.88 [95%CI 1.37-2.58]; cervicitis OR 1.42 [95%CI 0.61-2.96]). A diagnosis of urethritis in men was also significantly associated with M. genitalium infection (OR 2.97 [95%CI 2.14-4.13]). Few characteristics distinguished asymptomatic from symptomatic M. genitalium infections These results from persons seeking care in the United States, suggest that M. genitalium infection should be considered in young persons presenting with urogenital symptoms. Copyright © 2020 Manhart et al.Our objective was to evaluate the diagnostic yield and accuracy of the BioFire FilmArray Pneumonia Panel (BFPP) for identification of pathogens in lower respiratory tract specimens (n=200) from ED and ICU patients at a tertiary care academic medical center. Specimens were collected between January and November 2018, from patients ≥18 years of age, and had a culture performed as part of standard of care testing. The BFPP identified a viral or bacterial target in 117/200 (58.5%) samples, including Staphylococcus aureus in 22% of samples and Haemophilus influenzae in 14%, and both a viral and bacterial target in 4% of samples. The most common viruses detected by BFPP were rhinovirus/enterovirus (4.5%), influenza A (3%), and RSV (2%). Overall, there was strong correlation between BFPP and standard methods for detection of viruses (99.2%) and bacteria (96.8%). Most bacteria (60/61 [98.4%]) detected by standard methods were also identified by BFPP; and 92 additional bacteria were identified by BFPP alone, including 22/92 (23.9%) additional S. aureus and 25/92 (27.2%) H. influenzae, which were more frequently discordant when detected at low concentrations (S. aureus, p less then 0.001; H. influenzae, p less then 0.0001) and in sputum-type specimens (S. aureus, p less then 0.05). A potential limitation of the BFPP assay is the absence of fungal targets and Stenotrophomonas maltophilia, which were detected in 26 and 4 of 200 specimens, respectively. Real-time specimen analysis with BFPP has the potential to identify bacterial pathogens and resistance markers 44.2 and 56.3 h faster than culture-based methods. The BFPP is a rapid and accurate method for detection of pathogens from lower respiratory tract infections. Copyright © 2020 American Society for Microbiology.Background Compared to the standard two-tier testing algorithm (STTT) for Lyme disease serology using an enzyme immunoassay (EIA) followed by Western blot, data from the United States (US) suggests that a modified two-tiered testing (MTTT) algorithm employing two EIAs has improved sensitivity to detect early localized Borrelia burgdorferi infections, without compromising specificity. From 2011-2014, in the Canadian province of Nova Scotia where Lyme disease is hyperendemic, sera submitted for Lyme disease testing was subjected to a whole cell EIA, followed by C6 EIA and subsequently IgM and/or IgG immunoblots on sera with EIA positive or equivocal results. Here we evaluate the effectiveness of the MTTT algorithm compared to the STTT approach in a Nova Scotian population.Methods Retrospective chart reviews were performed on patients testing positive with the whole cell and C6 EIAs (i.e. MTTT algorithm). Patients were classified as having Lyme disease if they had a positive STTT result; a negative STTT result, but symptoms consistent with Lyme disease; or evidence of seroconversion on paired specimens.Results Of the 10253 specimens tested for Lyme disease serology, 9806 (95.6%) were negative. Of 447 patients that tested positive, 271 charts were available for review, and 227 were classified as patients with Lyme disease. The MTTT algorithm detected 25% more early infections with a specificity of 99.56% (99.41-99.68%) compared to the STTT.Conclusions This is the first Canadian data to show a MTTT has excellent specificity and improved sensitivity for detecting early B. burgdorferi infection compared to the STTT. Copyright © 2020 American Society for Microbiology.Group A Streptococcus (GAS) causes bacterial pharyngitis in both adults and children. Early and accurate diagnosis of GAS is important for appropriate antibiotic therapy to prevent GAS sequalae. The Revogene® Strep A molecular assay (Meridian Bioscience Canada Inc, Quebec City, QC) is an automated real time PCR assay for GAS detection from throat swab specimens within approximately 70 minutes. This multicenter prospective study evaluated the performance of Revogene Strep A molecular assay compared to that of bacterial culture. Dual throat swab specimens in either liquid Amies or Stuart medium were collected from eligible subjects (pediatric population and adults) enrolled across 7 sites (USA and Canada). Revogene Strep A and reference testing was performed within 7 days and 48 hours of sample collection respectively. Of the 604 evaluable specimens, GAS was detected in 154 (25.5%) samples by reference method and 175 (29%) samples by Revogene Strep A assay. Revogene Strep A assay sensitivity and specificity were reported to be 98.1% (95% confidence interval [lsqb]CI[rsqb], 94.4 - 99.3) and 94.7% (95% CI 92.2 - 96.4) respectively. The positive predictive value was 86.3% (95% CI 80.4 - 90.6), negative predictive value was 99.3% (95% CI 98.0 - 99.8) with 1.0% invalid rate. Discrepant analysis with alternative PCR/bidirectional sequencing was performed for 24 false positive (FP) and 3 false negative (FN) specimens. Concordant results were reported for 17 (FP only) of 27 discordant specimens. Revogene Strep A assay had high sensitivity and specificity for GAS detection and provides a faster alternative for GAS diagnosis. Copyright © 2020 American Society for Microbiology.BACKGROUND Several studies have investigated the association of breastfeeding status with offspring mortality in Africa, but most studies were from one center only or had limited statistical power to draw robust conclusions. METHODS Data came from 75 nationally representative cross-sectional Demographic and Health Surveys in 35 countries in sub-Saharan Africa conducted between 2000 and 2016. Our study relied on 217 112 individuals aged 4 days to 23 months for breastfeeding pattern analysis, 161 322 individuals aged 6 to 23 months for breastfeeding history analysis, and 104 427 individuals aged 12 to 23 months for breastfeeding duration analysis. RESULTS Compared with children aged 4 days to 23 months exclusively breastfed in the first 3 days of life, those not breastfed had a high risk of mortality at less then 2 years of age (odds ratio [OR] = 13.45; 95% confidence interval [CI] = 11.43-15.83). Young children who were predominantly breastfed or partially breastfed had moderately increased risk of mortality at less then 2 years of age (OR = 1.11, 95% CI = 1.03-1.21 for predominant pattern; OR = 1.12, 95% CI = 0.99-1.27 for partial pattern). Compared with children aged 6 to 23 months who were breastfed within the first 6 months of life, those not breastfed had a high risk of mortality (OR = 5.65; 95% CI = 4.27-7.47). Compared with children aged 12 to 23 months who were breastfed for ≥6 months, those who were breastfed for shorter periods had a higher risk of mortality (OR = 2.78, 95% CI = 1.45-5.32 for duration of less then 3 months; OR = 5.28, 95% CI = 3.24-8.61 for those who were not breastfed). CONCLUSIONS Our findings support exclusive breastfeeding during the first 6 months of life and continued breastfeeding up to 2 years of age recommended by the World Health Organization for reducing mortality of children less then 2 years old in sub-Saharan Africa. Copyright © 2020 by the American Academy of Pediatrics.BACKGROUND AND OBJECTIVES A previous single-county study found that retail stores usually asked young-looking tobacco customers to show proof-of-age identification, but a large proportion of illegal tobacco sales to minors occurred after the customers had shown identification proving they were too young to purchase tobacco. We sought to investigate these findings on a larger scale. METHODS We obtained state reports for federal fiscal years 2017 and 2018 from a federal agency that tracks tobacco sales to supervised minors conducting compliance checks in retail stores. We used descriptive and multivariable logistic regression methods to determine (1) how often stores in 17 states requested identifications, (2) what proportion of violations occurred after identification requests, and (3) if violation rates differed when minors were required versus forbidden to carry identification. RESULTS Stores asked minors for identification in 79.6% (95% confidence interval 79.3%-80.8%) of compliance checks (N = 17 276). Violations after identification requests constituted 22.8% (95% confidence interval 20.0%-25.6%; interstate range, 1.7%-66.2%) of all violations and were nearly 3 times as likely when minors were required to carry identification in compliance checks. Violations were 42% more likely when minors asked for a vaping product versus cigarettes. CONCLUSIONS Stores that sell tobacco to underage customers are more likely to be detected and penalized when youth inspectors carry identification during undercover tobacco sales compliance checks. The new age-21 tobacco sales requirement presents an opportunity to require identifications be carried and address other long-standing weaknesses in compliance-check protocols to help combat the current adolescent vaping epidemic. Copyright © 2020 by the American Academy of Pediatrics.BACKGROUND Preoperative education may help participants to psychologically prepare themselves for surgery, but the outcomes of such preparation have rarely been assessed in patients requiring postoperative care in the intensive care unit (ICU) as well as in family members. OBJECTIVE To assess the effect of a preoperative multifaceted education intervention on patient and family satisfaction levels in the ICU and measures of perioperative patients' anxiety and depression. TRIAL DESIGN Single-centre, two-armed, parallel, superiority, randomised controlled trial. Healthcare professionals in ICU and outcome assessor were blinded to treatment allocation. PARTICIPANTS 100 elective coronary artery bypass grafting±valve surgery patients and their family members. INTERVENTIONS Preoperative education comprising of a video and ICU tour in addition to standard care (treatment), versus standard care (control). OUTCOMES Patient and family satisfaction levels with ICU using validated PS-ICU23 and FS-ICU24 questionnaires (0-1. © Author(s) (or their employer(s)) 2020. No commercial re-use. Selleckchem FPH1 See rights and permissions. Published by BMJ.Prostate cancer is the second leading cause of cancer-associated death in men. Despite having a relatively lower tumor mutational burden than most tumor types, multiple gene fusions such as TMPRSS2ERG have been characterized and linked to more aggressive disease. Individual tumor samples have been found to contain multiple fusions and it remains unknown whether these fusions increase tumor immunogenicity. Here, we investigated the role of fusion burden on the prevalence and expression of key molecular and immune effectors in prostate cancer tissue specimens which represented the different stages of disease progression and androgen sensitivity, including hormone sensitive and castration resistant prostate cancer. We found that tumor fusion burden was inversely correlated with tumor mutational burden and not associated with disease stage. High fusion burden correlated with high immune infiltration, PD-L1 expression on immune cells, and immune signatures representing activation of T cells and M1 macrophages. High fusion burden inversely correlated with immune suppressive signatures.