Role of rhinovirus load in the upper respiratory tract and severity of symptoms in lung transplant recipients.

BACKGROUND: Rhinovirus is the most common cause of respiratory viral infections and leads to frequent respiratory symptoms in lung transplant recipients. However, it remains unknown whether the rhinovirus load correlates with the severity of symptoms. OBJECTIVES: This study aimed to better characterize the pathogenesis of rhinoviral infection and the way in which viral load correlates with symptoms. STUDY DESIGN: We assessed rhinovirus load in positive upper respiratory specimens of patients enrolled prospectively in a cohort of 116 lung transplant recipients. Rhinovirus load was quantified according to a validated in-house, real-time, reverse transcription polymerase chain reaction in pooled nasopharyngeal and pharyngeal swabs. Symptoms were recorded in a standardised case report form completed at each screening/routine follow-up visit, or during any emergency visit occurring during the 3-year study. RESULTS: Rhinovirus infections were very frequent, including in asymptomatic patients not seeking a specific medical consultation. Rhinovirus load ranged between 4.1 and 8.3 log copies/ml according to the type of visit and clinical presentation. Patients with highest symptom scores tended to have higher viral loads, particularly those presenting systemic symptoms. When considering symptoms individually, rhinovirus load was significantly higher in the presence of symptoms such as sore throat, fever, sputum production, cough, and fatigue. There was no association between tacrolimus levels and rhinovirus load. CONCLUSIONS: Rhinovirus infections are very frequent in lung transplant recipients and rhinoviral load in the upper respiratory tract is relatively high even in asymptomatic patients. Patients with the highest symptom scores tend to have a higher rhinovirus load.

Forecasting tourism demand using consumer expectations

Abstract Purpose- There is a lack of studies on tourism demand forecasting that use non-linear models. The aim of this paper is to introduce consumer expectations in time-series models in order to analyse their usefulness to forecast tourism demand. Design/methodology/approach- The paper focuses on forecasting tourism demand in Catalonia for the four main visitor markets (France, the UK, Germany and Italy) combining qualitative information with quantitative models: autoregressive (AR), autoregressive integrated moving average (ARIMA), self-exciting threshold autoregressions (SETAR) and Markov switching regime (MKTAR) models. The forecasting performance of the different models is evaluated for different time horizons (one, two, three, six and 12 months). Findings- Although some differences are found between the results obtained for the different countries, when comparing the forecasting accuracy of the different techniques, ARIMA and Markov switching regime models outperform the rest of the models. In all cases, forecasts of arrivals show lower root mean square errors (RMSE) than forecasts of overnight stays. It is found that models with consumer expectations do not outperform benchmark models. These results are extensive to all time horizons analysed. Research limitations/implications- This study encourages the use of qualitative information and more advanced econometric techniques in order to improve tourism demand forecasting. Originality/value- This is the first study on tourism demand focusing specifically on Catalonia. To date, there have been no studies on tourism demand forecasting that use non-linear models such as self-exciting threshold autoregressions (SETAR) and Markov switching regime (MKTAR) models. This paper fills this gap and analyses forecasting performance at a regional level. Keywords Tourism, Forecasting, Consumers, Spain, Demand management Paper type Research paper

PTX3 Polymorphisms and Invasive Mold Infections After Solid Organ Transplant.

Donor PTX3 polymorphisms were shown to influence the risk of invasive aspergillosis among hematopoietic stem cell transplant recipients. Here, we show that PTX3 polymorphisms are independent risk factors for invasive mold infections among 1101 solid organ transplant recipients, thereby strengthening their role in mold infection pathogenesis and patients' risk stratification.

The swiss transplant cohort study: lessons from the first 6 years.

Prospective cohort studies significantly contribute to answering specific research questions in a defined population. Since 2008, the Swiss Transplant Cohort Study (STCS) systematically enrolled >95 % of all transplant recipients in Switzerland, collecting predefined data at determined time points. Designed as an open cohort, the STCS has included >3900 patients to date, with a median follow-up of 2.96 years (IQR 1.44-4.73). This review highlights some relevant findings in the field of transplant-associated infections gained by the STCS so far. Three key general aspects have crystallized: (i) Well-run cohort studies are a powerful tool to conduct genetic studies, which are crucially dependent on a meticulously described phenotype. (ii) Long-term real-life observations are adding a distinct layer of information that cannot be obtained during randomized studies. (iii) The systemic collection of data, close interdisciplinary collaboration, and continuous analysis of some key outcome data such as infectious diseases endpoints can improve patient care.

CCL8 and the Immune Control of Cytomegalovirus in Organ Transplant Recipients.

Monitoring of cytomegalovirus cell-mediated immunity is a promising tool for the refinement of preventative and therapeutic strategies posttransplantation. Typically, the interferon-γ response to T cell stimulation is measured. We evaluated a broad range of cytokine and chemokines to better characterize the ex vivo host-response to CMV peptide stimulation. In a cohort of CMV viremic organ transplant recipients, chemokine expression-specifically CCL8 (AUC 0.849 95% CI 0.721-0.978; p = 0.003) and CXCL10 (AUC 0.841, 95% CI 0.707-0.974; p = 0.004)-was associated with control of viral replication. In a second cohort of transplant recipients at high-risk for CMV, the presence of a polymorphism in the CCL8 promoter conferred an increased risk of viral replication after discontinuation of antiviral prophylaxis (logrank hazard ratio 3.6; 95% CI 2.077-51.88). Using cell-sorting experiments, we determined that the primary cell type producing CCL8 in response to CMV peptide stimulation was the monocyte fraction. Finally, in vitro experiments using standard immunosuppressive agents demonstrated a dose-dependent reduction in CCL8 production. Chemokines appear to be important elements of the cell-mediated response to CMV infection posttransplant, as here suggested for CCL8, and translation of this knowledge may allow for the tailoring and improvement of preventative strategies.

Clinical outcomes of lung transplant recipients with telomerase mutations.

BACKGROUND: Successful lung transplantation for patients with pulmonary fibrosis from telomerase mutations may be limited by systemic complications of telomerase dysfunction, including myelosuppression, cirrhosis, and malignancy. We describe clinical outcomes in 14 lung transplant recipients with telomerase mutations. METHODS: Subjects underwent lung transplantation between February 2005 and April 2014 at 5 transplant centers. Data were abstracted from medical records, focusing on outcomes reflecting post-transplant treatment effects likely to be complicated by telomerase mutations. RESULTS: The median age of subjects was 60.5 years (interquartile range = 52.0-62.0), 64.3% were male, and the mean post-transplant observation time was 3.2 years (SD ± 2.9). A mutation in telomerase reverse transcriptase was present in 11 subjects, a telomerase RNA component mutation was present in 2 subjects, and an uncharacterized mutation was present in 1 subject. After lung transplantation, 10 subjects were leukopenic and 5 did not tolerate lymphocyte anti-proliferative agents. Six subjects developed recurrent lower respiratory tract infections, 7 developed acute cellular rejection (A1), and 4 developed chronic lung allograft dysfunction. Eight subjects developed at least 1 episode of acute renal failure and 10 developed chronic renal insufficiency. In addition, 3 subjects developed cancer. No subjects had cirrhosis. At data censorship, 13 subjects were alive. CONCLUSIONS: The clinical course for lung transplant recipients with telomerase mutations is complicated by renal disease, leukopenia with intolerance of lymphocyte anti-proliferative agents, and recurrent lower respiratory tract infections. In contrast, cirrhosis was absent, acute cellular rejection was mild, and development of chronic lung allograft dysfunction was comparable to other lung transplant recipients. Although it poses challenges, lung transplantation may be feasible for patients with pulmonary fibrosis from telomerase mutations.

The impact of inbound demand on price levels in tourism municipalities : Empirical evidence from Catalonia

It is usually argued that tourism exerts negative economic impacts in host jurisdictions through the increase in prices linked to increasing demand for basic services and goods from tourists. This paper surveys 149 products in 45 tourism and non-tourism jurisdictions in Catalonia (which represent a total of 18,500 prices) in order to test empirically several hypotheses related to differences in price levels in tourism and non-tourism jurisdictions. The main results show that prices in tourism jurisdictions are not significantly higher than those in non-tourism ones. The analysis suggests that tourists are likely to pay higher prices than natives for some products

How Important to a City Are Tourists and Daytrippers? The Economic Impact of Tourism on The City of Barcelona

In this paper, we devise a methodology that is able to objectively quantify the impact of tourism on the urban economy. This methodology takes various dimensions into account. First, to analyse the impact at sectoral level, it should bear in mind that tourism is a cross-sectional activity which affects many sectors, both directly and indirectly. Therefore, it is important to consider the impact of urban tourism on sectors traditionally defined as tourism-related, -that is, hotels, restaurants, shops, etc.- but also its impact on other sectors -for instance, textiles, food, construction, to name only a few- due to the intersectoral relationships that emerge. Second, we need to calculate the percentage of the turnover of each sector that is due to the tourism industry. Third, it is important to establish the geographic distribution of this impact: how is the effect shared between the city and its neighbouring areas QUESTION Finally, the effect of urban tourism should be quantified not only in terms of turnover, but also in terms of its contribution to GDP and employment.

Quality of life in simultaneous pancreas-kidney transplant recipients

Currently, simultaneous pancreas-kidney transplantation (SPK Tx) is the treatment of choice in selected patients with type 1 diabetes mellitus (DM1) and terminal kidney failure (TRF). A functioning SPK transplant allows dialysis and insulin therapy to be discontinued and stabilizes or improves the complications of DM1. Nevertheless, to a greater or lesser degree, these complications (physical and psychological alterations, secondary effects of immunosuppressive therapy and the need for lifelong medication and medical follow-up) can persist after SPK Tx. Health professionals have mainly investigated the clinical features of transplant recipients. However, in the last few years, interest in analyzing perceived health and health-related quality of life (QoL) has increased. This latter concept includes the features of QoL most closely associated with a particular disease, its treatment and follow-up and therefore those elements most susceptible to modification by the health system. The general aim of this study was to measure health-related QoL in our population with SPK Tx and to determine whether there are significant differences between these patients and those with DM1 and TRF who continue to receive renal replacement therapy (RRT) and insulin therapy. More specific aims were to evaluate whether there are significant differences between the study groups and the means of the Spanish reference population in the distinct dimensions of a QoL questionnaire and whether other variables such as age, sex, years" duration of DM1, length of dialysis, and time since SPK Tx significantly affect health-related QoL.

Quality of life in simultaneous pancreas-kidney transplant recipients

Currently, simultaneous pancreas-kidney transplantation (SPK Tx) is the treatment of choice in selected patients with type 1 diabetes mellitus (DM1) and terminal kidney failure (TRF). A functioning SPK transplant allows dialysis and insulin therapy to be discontinued and stabilizes or improves the complications of DM1. Nevertheless, to a greater or lesser degree, these complications (physical and psychological alterations, secondary effects of immunosuppressive therapy and the need for lifelong medication and medical follow-up) can persist after SPK Tx. Health professionals have mainly investigated the clinical features of transplant recipients. However, in the last few years, interest in analyzing perceived health and health-related quality of life (QoL) has increased. This latter concept includes the features of QoL most closely associated with a particular disease, its treatment and follow-up and therefore those elements most susceptible to modification by the health system. The general aim of this study was to measure health-related QoL in our population with SPK Tx and to determine whether there are significant differences between these patients and those with DM1 and TRF who continue to receive renal replacement therapy (RRT) and insulin therapy. More specific aims were to evaluate whether there are significant differences between the study groups and the means of the Spanish reference population in the distinct dimensions of a QoL questionnaire and whether other variables such as age, sex, years" duration of DM1, length of dialysis, and time since SPK Tx significantly affect health-related QoL.

Quality of life in simultaneous pancreas-kidney transplant recipients

Currently, simultaneous pancreas-kidney transplantation (SPK Tx) is the treatment of choice in selected patients with type 1 diabetes mellitus (DM1) and terminal kidney failure (TRF). A functioning SPK transplant allows dialysis and insulin therapy to be discontinued and stabilizes or improves the complications of DM1. Nevertheless, to a greater or lesser degree, these complications (physical and psychological alterations, secondary effects of immunosuppressive therapy and the need for lifelong medication and medical follow-up) can persist after SPK Tx. Health professionals have mainly investigated the clinical features of transplant recipients. However, in the last few years, interest in analyzing perceived health and health-related quality of life (QoL) has increased. This latter concept includes the features of QoL most closely associated with a particular disease, its treatment and follow-up and therefore those elements most susceptible to modification by the health system. The general aim of this study was to measure health-related QoL in our population with SPK Tx and to determine whether there are significant differences between these patients and those with DM1 and TRF who continue to receive renal replacement therapy (RRT) and insulin therapy. More specific aims were to evaluate whether there are significant differences between the study groups and the means of the Spanish reference population in the distinct dimensions of a QoL questionnaire and whether other variables such as age, sex, years" duration of DM1, length of dialysis, and time since SPK Tx significantly affect health-related QoL.

Tourism Demand in Catalonia: detecting external economic factors

There is a lack of studies on tourism demand in Catalonia. To fill the gap, this paper focuses on detecting the macroeconomic factors that determine tourism demand in Catalonia. We also analyse the relation between these factors and tourism demand. Despite the strong seasonal component and the outliers in the time series of some countries, overnight stays give a better indication of tourism demand in Catalonia than the number of tourists. The degree of linear association between the macroeconomic variables and tourism demand is also higher when using quarterly rather than monthly data. Finally, there are notable differences between the results obtained for the different countries analysed. These results indicate that the best way to model tourism demand in Catalonia is to specify a quarterly model of overnight stays, differentiating between an aggregate demand model for the total number of tourists and specific models for each of the countries analysed.

Managing induced tourism image : relational patterns and the life cycle

The tourism image is an element that conditions the competitiveness of tourism destinations by making them stand out in the minds of tourists. In this context, marketers of tourism destinations endeavour to create an induced image based on their identity and distinctive characteristics.A number of authors have also recognized the complexity of tourism destinations and the need for coordination and cooperation among all tourism agents, in order to supply a satisfactory tourist product and be competitive in the tourism market. Therefore, tourism agents at the destination need to develop and integrate strategic marketing plans.The aim of this paper is to determine how cities of similar cultures use their resources with the purpose of developing a distinctive induced tourism image to attract tourists and the extent of coordination and cooperation among the various tourism agents of a destination in the process of induced image creation.In order to accomplish these aims, a comparative analysis of the induced image of two cultural cities is presented, Girona (Spain) and Perpignan (France). The induced image is assessed through the content analysis of promotional brochures and the extent of cooperation with in-depth interviews of the main tourism agents of these destinations.Despite the similarities of both cities in terms of tourism resources, results show the use of different attributes to configure the induced image of each destination, as well as a different configuration of the network of tourism agents that participate in the process of induced image creation