Diagnostic accuracy of loop-mediated isothermal amplification as a near-patient test for meningococcal disease in children: An observational cohort study

Background: Diagnosis of meningococcal disease relies on recognition of clinical signs and symptoms that are notoriously non-specific, variable, and often absent in the early stages of the disease. Loop-mediated isothermal amplification (LAMP) has previously been shown to be fast and effective for the molecular detection of meningococcal DNA in clinical specimens. We aimed to assess the diagnostic accuracy of meningococcal LAMP as a near-patient test in the emergency department.

Methods: For this observational cohort study of diagnostic accuracy, children aged 0-13 years presenting to the emergency department of the Royal Belfast Hospital for Sick Children (Belfast, UK) with suspected meningococcal disease were eligible for inclusion. Patients underwent a standard meningococcal pack of investigations testing for meningococcal disease. Respiratory (nasopharyngeal swab) and blood specimens were collected from patients and tested with near-patient meningococcal LAMP and the results were compared with those obtained by reference laboratory tests (culture and PCR of blood and cerebrospinal fluid).

Findings: Between Nov 1, 2009, and Jan 31, 2012, 161 eligible children presenting at the hospital underwent the meningococcal pack of investigations and were tested for meningococcal disease, of whom 148 consented and were enrolled in the study. Combined testing of respiratory and blood specimens with use of LAMP was accurate (sensitivity 89% [95% CI 72-96], specificity 100% [97-100], positive predictive value 100% [85-100]; negative predictive value 98% [93-99]) and diagnostically useful (positive likelihood ratio 213 [95% CI 13-infinity] and negative likelihood ratio 0·11 [0·04-0·32]). The median time required for near-patient testing from sample to result was 1 h 26 min (IQR 1 h 20 min-1 h 32 min).

Interpretation: Meningococcal LAMP is straightforward enough for use in any hospital with basic laboratory facilities, and near-patient testing with this method is both feasible and effective. By contrast with existing UK National Institute of Health and Care Excellence guidelines, we showed that molecular testing of non-invasive respiratory specimens from children is diagnostically accurate and clinically useful.

PAlliative Care in chronic Kidney diSease: the PACKS study—quality of life, decision making, costs and impact on carers in people managed without dialysis

BACKGROUND: The number of patients with advanced chronic kidney disease opting for conservative management rather than dialysis is unknown but likely to be growing as increasingly frail patients with advanced renal disease present to renal services. Conservative kidney management includes ongoing medical input and support from a multidisciplinary team. There is limited evidence concerning patient and carer experience of this choice. This study will explore quality of life, symptoms, cognition, frailty, performance decision making, costs and impact on carers in people with advanced chronic kidney disease managed without dialysis and is funded by the National Institute of Health Research in the UK.

METHODS: In this prospective, multicentre, longitudinal study, patients will be recruited in the UK, by renal research nurses, once they have made the decision not to embark on dialysis. Carers will be asked to 'opt-in' with consent from patients. The approach includes longitudinal quantitative surveys of quality of life, symptoms, decision making and costs for patients and quality of life and costs for carers, with questionnaires administered quarterly over 12 months. Additionally, the decision making process will be explored via qualitative interviews with renal physicians/clinical nurse specialists.

DISCUSSION: The study is designed to capture patient and carer profiles when conservative kidney management is implemented, and understand trajectories of care-receiving and care-giving with the aim of optimising palliative care for this population. It will explore the interactions that lead to clinical care decisions and the impact of these decisions on informal carers with the intention of improving clinical outcomes for patients and the experiences of care givers.

The role of implicit theories in the formation of expert opinion in portuguese criminal law

Tese de doutoramento, Ciências e Tecnologias da Saúde (Medicina Legal e Ciências Forenses), Universidade de Lisboa, Faculdade de Medicina, 2014

The river solofrana bicycle network: a project of green mobility

The article presents the “LungoSolofrana” project, carried out during the course “Urban and Mobility” in the academic year 2009/2010, held during the bachelor in Environmental Engineering at the University of Naples “Federico II”. The work has also been chosen as a finalist at the “UrbanPromo 2010” contest, the urban and territorial marketing event sponsored by the National Institute of Urban Planning and Urbit which was held in Venice in 2010. The project consists in a green mobility proposal, developed with an approach based on the integration of the environmental redevelopment of a portion of river Solofrana, located in the Salerno Province, and of the renewal of seven local stations of the railway line Mercato San Severino – Nocera Inferiore, including the realization of a cycle-path network for the natural environment fruition. Furthermore the work drew attention to the local and regional administration. The main intent of the project is to integrate sustainable mobility themes with the environment recovery in a territory affected by high environmental troubles. The area includes the municipalities of Nocera Inferiore, Nocera Superiore, Mercato San Severino, Castel San Giorgio and Roccapiemonte, situated in Salerno’s province, with a total population about 114.000 (font Demo ISTAT 2010). The area extension is about 84,30 sqkm and it is crossed by river Solofrana that is the central point of the project idea. The intervention strategy is defined in two kinds of actions: internal and external rail station interventions. The external rail station interventions regard the construction of pedestrian-cycle paths with the scope of increasing the spaces dedicated to cyclists and to pedestrians along the river Solofrana sides and to connect the urban areas with the railway station. In this way, it’s also possible to achieve an urban requalification of the interested area. On the other side, the interventions inside the station , according to Transit Oriented Development principles, aim at redeveloping common spaces with the insertion of new activities and at realizing new automatic cycle parks covered by photovoltaic panels. The project proposal consists of the urban regeneration of small railway stations along the route-Nocera-Codola Mercato San Severino in the province of Salerno, through interventions aimed at improving pedestrian accessibility. The project involves in particular the construction of pedestrian paths protected access to the station and connecting with neighboring towns and installation of innovative bike parking stations in elevation, covering surfaces coated with solar panels and spaces information. The project is aimed to propose a new model of sustainable transport for small and medium shifts as an alternative to private transportation