BG Test Research Articles

Variable reliability of the (1,3)-β-d-glucan test for screening Pneumocystis pneumonia in HIV-negative patients depending on the underlying condition.

(1,3)-β-d-Glucan (BG) assay is a non-invasive test commonly used in the diagnostic of invasive fungal diseases. Given its high sensitivity, it was suggested that a negative BG result is sufficient for excluding the diagnosis of Pneumocystis pneumonia (PCP). However, suboptimal performance has been described in human immunodeficiency virus (HIV)-negative patients, particularly those with haematological malignancies. We aimed to assess the sensitivity of the BG assay for diagnosing PCP in HIV-negative patients based on their underlying PCP risk factors. We conducted a single-center, retrospective study (2009-2021) enrolling HIV-negative patients diagnosed with PCP and who underwent BG testing. Patients colonized with Pneumocystis jirovecii were included as a control group. In all, 55 PCP patients and 61 colonized patients met the inclusion criteria. Patients were further categorized according to the underlying condition that exposes patients to PCP. Median BG concentration was significantly higher in the PCP group than in the colonization group (500 vs. 31 pg/ml; P<10-4, Mann-Whitney test) and the BG assay demonstrated a sensitivity of 85% and a specificity of 82% for PCP diagnosis. Notably, sensitivity was significantly higher in non-cancer patients (100%) compared to those with solid cancer (72%) and haematologic cancer (79%) (P<.05, Fischer's exact test). These findings strengthen the high performance of BG testing for screening PCP in non-cancer patients, comparable to that observed in HIV-infected individuals. In contrast, they highlight its low reliability in patients with malignancies, emphasizing the importance of considering underlying conditions when interpreting BG results and refining the role of the test in PCP diagnosis.

Diagnostic performance of serum galactomannan and β-D-glucan for invasive aspergillosis in suspected patients: A meta-analysis.

Serum galactomannan (GM) and β-D-glucan (BG) are known markers of invasive aspergillosis (IA). The aim of this meta-analysis was to evaluate the efficiency of serum GM and BG as diagnostic markers of symptomatic IA infection and compare the performance of the combined tests with that of either test individually. A literature search was carried out using PubMed, Web of Science, and EMBASE databases to include relevant studies published in English up to May 2023. The quality assessment was performed using Review Manager 5.3 software. A bivariate model was applied to pool diagnostic parameters using Stata 14.0 software. We used Cochrane I2 index to assess heterogeneity and identify the potential source of heterogeneity by meta-regression. Paired t tests were used to compare the value of GM and BG for IA diagnosis when used in combination or alone. Sixteen studies were eligible for inclusion in the meta-analysis. For proven or probable IA, serum GM and BG yielded a pooled sensitivity of 0.53 (95% CI 0.40-0.66) vs 0.72 (95% CI 0.61-0.81) and a pooled specificity of 0.94 (95% CI 0.91-0.97) vs 0.82 (95% CI 0.73-0.88). The area under the curve (AUC) of ROC was 0.90 (95% CI 0.87-0.92) vs 0.83 (95% CI 0.80-0.86) for all studies. The pooled sensitivity and specificity for IA diagnosis by combined GM and BG assays (GM/BG) were 0.84 (95% CI 0.69-0.86) and 0.76 (95% CI 0.69-0.81), respectively. The sensitivity of the combined GM/BG test to diagnose IA was higher than of the GM or BG test alone. Serum GM and BG tests had a relatively high accuracy for IA diagnosis in suspected patients. The diagnostic accuracy of both assays is comparable, and the diagnostic sensitivity is further improved by the combined detection of the 2 markers.

An experimental assessment on dual fuel engine behavior powered by waste tire-derived pyrolysis oil – biogas blends

This paper is intended to investigate the usability of waste tire pyrolysis oil along with diesel and biogas dual fuel in the CI engines. In this framework, the waste tire chips are firstly pyrolyzed in the study, and then are volumetrically blended into the conventional diesel fuel (DF) at the ratio of 20%. The biogas flow rate changes as 0.5, 1, and 2 L/min when the engine is fuelled by P20 test fuel. Throughout the experiments, the engine runs at a fixed engine speed of 1500 rpm under 2.5, 5, 7.5 and 10 Nm. In the results, it is noticed that the unburnt emissions such as CO and HC considerably increases with the presence of pyrolysis oil and biogas in the cylinder due to the lack of oxygen and lower heating value of these fuels. However, the NOx firstly rises with the diesel-pyrolysis oil blends by 2.21% but then pulls back with the introduction of biogas to the combustion chamber. It drops by 2.29%, 4.93%, and 11.14% for P20 + 0.5 BG, P20 + 1 BG, and P20 + 2 BG test fuels, respectively in comparison to that of DF. On the other hand, the engine performance worsens with the pyrolysis oil due to the lower energy content. Accordingly, the increment on BSFC is found to be 9.28%, 25.15%, 42.51%, and 67.68%, and the reduction on BTE is found to be 8.47%, 17.72%, 25.52%, and 33.48% for P20, P20 + 0.5 BG, P20 + 1 BG, and P20 + 2 BG test fuels, respectively. It is concluded that even if they worsen the engine performance and exhaust emissions, the burning of waste products in the forms of pyrolysis oil and biogas as fuel substitutions in CI engines seems a very promising way in terms of waste management, disposal the huge volume of waste products from the nature, and protection of rapidly depletion fossil fuel reserves.

Endocrine Dysfunction Criteria in Critically Ill Children: The PODIUM Consensus Conference.

Endocrine dysfunction is common in critically ill children and is manifested by abnormalities in glucose, thyroid hormone, and cortisol metabolism. To develop consensus criteria for endocrine dysfunction in critically ill children by assessing the association of various biomarkers with clinical and functional outcomes. PubMed and Embase were searched from January 1992 to January 2020. We included studies in which researchers evaluated critically ill children with abnormalities in glucose homeostasis, thyroid function and adrenal function, performance characteristics of assessment and/or scoring tools to screen for endocrine dysfunction, and outcomes related to mortality, organ-specific status, and patient-centered outcomes. Studies of adults, premature infants or animals, reviews and/or commentaries, case series with sample size ≤10, and non-English-language studies were excluded. Data extraction and risk-of-bias assessment for each eligible study were performed by 2 independent reviewers. The systematic review supports the following criteria for abnormal glucose homeostasis (blood glucose [BG] concentrations >150 mg/dL [>8.3 mmol/L] and BG concentrations <50 mg/dL [<2.8 mmol/L]), abnormal thyroid function (serum total thyroxine [T4] <4.2 μg/dL [<54 nmol/L]), and abnormal adrenal function (peak serum cortisol concentration <18 μg/dL [500 nmol/L]) and/or an increment in serum cortisol concentration of <9 μg/dL (250 nmol/L) after adrenocorticotropic hormone stimulation. These included variable sampling for BG measurements, limited reporting of free T4 levels, and inconsistent interpretation of adrenal axis testing. We present consensus criteria for endocrine dysfunction in critically ill children that include specific measures of BG, T4, and adrenal axis testing.

A Negative (1,3)-β-D-Glucan Result Alone Is Not Sufficient to Rule Out a Diagnosis of Pneumocystis Pneumonia in Patients With Hematological Malignancies.

Background: Serum (1,3)-β-D-glucan (BG) testing is increasingly being used in the diagnostic armamentarium for invasive fungal diseases. Given its high sensitivity, some studies suggest that a negative BG result contributes to rule out a diagnosis of Pneumocystis pneumonia (PCP). However, recent reports described a suboptimal sensitivity in HIV-negative immunocompromised patients. In this study, we evaluated the performance of BG assay for PCP diagnosis in HIV-negative patients with diverse PCP risk factors. We also assessed the correlation between Pneumocystis jirovecii load in pulmonary samples and serum BG levels.Methods: We retrospectively included HIV-negative patients with microscopically proven PCP and for whom a BG result was available. We also enrolled patients colonized by Pneumocystis as control group. Colonized patients were matched with PCP patients based on their underlying condition that exposed to PCP. Pulmonary fungal loads were determined by an in-house real-time PCR, and BG levels were measured by using the Fungitell® kit (Associates of Cape Cod, Inc.).Results: Thirty-nine patients were included in each of the two groups. Thirty-four of 39 PCP patients and one of 39 colonized patient had a positive BG test, resulting in a sensitivity of 0.87 (95% CI: 0.73–0.94), a specificity of 0.97 (95% CI: 0.87–0.99), a positive predictive value of 0.97 (95% CI: 0.85–0.99), and a negative predictive value of 0.88 (95% CI: 0.75–0.95) for BG assay. Nonetheless, median BG level differed according to the underlying condition. Among the PCP group, the lowest median level of 211 pg/ml was observed in patients with hematological malignancy (HM) and differed significantly from that observed either in solid organ transplants (3,473 pg/ml) or in patients with autoimmune or inflammatory disorder (3,480 pg/ml). Indeed, the sensitivity of BG assay was estimated at 0.64 (95% CI: 0.35–0.85) in HM patients and was lower than the one observed in the whole PCP group. Furthermore, BG level and fungal burden correlated poorly among all PCP patients.Conclusion: BG is not a reliable biomarker for ruling out PCP in HIV-negative patients with HM. Interpretation of a negative BG result should take into account, but not be limited to, the underlying condition predisposing to PCP.

The Impact of a Nursing Strike on Glycemic Control in Hospitalized Patients with Diabetes.

IntroductionHyperglycemia and hypoglycemia have been found to increase morbidity and mortality among hospitalized patients with diabetes. In July of 2018, our academic medical center experienced a 48-hour nursing strike, during which time 600 replacement nurses were employed. This cohort study evaluated the impact of the nursing strike on glycemic control among hospitalized patients with diabetes.MethodsPoint-of-care fingerstick blood glucose (POC BG) values among hospitalized patients with diabetes were compared between the 48-hour nursing strike period and two 48-hour periods when the nursing strike did not occur. We evaluated the percentage of POC BG values that were hyperglycemic (POC BG 181-250 mg/dL), severely hyperglycemic (POC BG >250 mg/dL), and hypoglycemic (POC BG <70 mg/dL). Additionally, we assessed the proportion of patients who experienced one or more days of hypoglycemia, hyperglycemia, or severe hyperglycemia.ResultsWe found a significant association between the distributions of POC BG test results during the nursing strike; test results more frequently showed hyperglycemia, severe hyperglycemia, or hypoglycemia during the nursing strike than during the control period (p=0.006). There was a significant difference in the days of hypoglycemia, with 7.7% of patients experiencing one or more days of hypoglycemia during the strike period compared with 1.4% of patients during the control period (p=0.03).ConclusionNursing strikes have been employed as a last resort in contract negotiations with hospitals, but they have the potential to significantly affect patient care and safety. Further studies are needed to evaluate these impacts to prepare for future workforce disruptions.

607-P: Glycemic Metrics in Japanese Flash Glucose Monitoring Users by Diabetes Type and Therapy

Our aim was to assess differences in glycemic metrics according to diabetes type and therapy in Japan. An optional survey was conducted for users of FreeStyle LibreTM readers in Japan (Jun2020 - Oct2020). Survey responses were linked to glucose data from Jan2017 - Oct2020. Four groups (adults) were used: type 1 diabetes (T1), type 2 on intensive insulin (T2 MDI), T2 on basal or pre-mixed insulin (T2 non-MDI), and T2 not on insulin (T2 non-insulin). A total of 2,434 users in Japan were analyzed: 1,237 T1, 429 T2 MDI, 256 T2 non-MDI, and 512 T2 non-insulin. Glucose control for T2 MDI and T2 non-MDI groups was similar. Mean avg glucose for T1 was similar to T2 insulin users, but TIR was lower and TB70 was higher for T1. The non-insulin group had high engagement (mean 21 scans/day), but tested BG less than once/day prior to the sensor. These patients also largely pay for the device without reimbursement and have more recent diabetes diagnoses than other groups. These data show the variety of users of the FreeStyle Libre system in Japan. The non-insulin group's engagement through high average scan rates despite lack of consistent BG testing before using the sensor demonstrates that patients find value in easier monitoring. High scan rates in all groups indicate that scanning is not a barrier to glucose monitoring. The data selects those users who responded to the optional survey but is comparable to the overall glucose control of all users in Japan.View largeDownload slideView largeDownload slide DisclosureW. Ogawa: Advisory Panel; Self; Abbott Diabetes, Novo Nordisk Pharma Ltd., Research Support; Self; Eli Lilly Japan K. K., Nippon Boehringer Ingelheim Co. Ltd., Takeda Pharmaceutical Co., Speaker's Bureau; Self; Dainippon Sumitomo Pharm, Kowa Company, Ltd., MSD K. K., Novartis Pharma K. K., Ono Pharmaceutical Co., Ltd. T. Urakami: None. T. Kadowaki: Other Relationship; Self; Asahi Mutual Life Insurance Company, MSD Corporation, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Pharma Ltd., Takeda Pharmaceutical Company Limited, Research Support; Self; Daiichi Sankyo Company, Limited, Eli Lilly Japan K. K., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K. K., Sumitomo Dainippon Pharma Co., Ltd., Takeda Pharmaceutical Co., Speaker's Bureau; Self; Astellas Pharma Inc., AstraZeneca, Daiichi Sankyo Company, Limited, Eli Lilly Japan K. K., Kowa Company, Ltd., Kyowa Kirin Co., Ltd., Mitsubishi Tanabe Pharma Corporation, MSD Corporation, Nippon Boehringer Ingelheim Co. Ltd., Novo Nordisk Pharma Ltd., Ono Pharmaceutical Co., Ltd., Sanofi K. K., Sanwa Kagaku Kenkyusho, Sumitomo Dainippon Pharma Co., Ltd., Taisho Pharmaceutical Co., Ltd., Taisho Pharmaceutical Co., Ltd. K. Kao: Employee; Self; Abbott Diabetes. L. Brandner: Employee; Self; Abbott Diabetes. K. Shimizu: Employee; Self; Abbott Japan Co., Ltd. T. Dunn: Employee; Self; Abbott Diabetes.

The Impact of Cesarean and Vaginal Delivery on Results of Psychological Cognitive Test in 5 Year Old Children.

Background and objectives: The impact of cesarean and vaginal delivery on cognitive development was analyzed in 5 year old children. Materials and Methods: Two cohorts of 5 year old children born in the years 2013 and 2014 in Karvina (Northern Moravia) and Ceske Budejovice (Southern Bohemia) were studied for their cognitive development related to vaginal (n = 117) and cesarean types of delivery (n = 51). The Bender Visual Motor Gestalt Test (BG test) and the Raven Colored Progressive Matrices (RCPM test) were used as psychological tests. Results: In the comparison of vaginal delivery vs. cesarean section, the children delivered by cesarean section scored lower and, therefore, achieved poorer performance in cognitive tests compared to those born by vaginal delivery, as shown in the RCPM (p < 0.001) and in the BG test (p < 0.001). When mothers’ education level was considered, the children whose mothers achieved a university degree scored higher in both the RCPM test (p < 0.001) and the BG test (p < 0.01) compared to the children of mothers with lower secondary education. When comparing mothers with a university degree to those with higher secondary education, there was a significant correlation between level of education and score achieved in the RCPM test (p < 0.001), but not in the BG test. Conclusions: According to our findings, the mode of delivery seems to have a significant influence on performance in psychological cognitive tests in 5 year old children in favor of those who were born by vaginal delivery. Since cesarean-born children scored notably below vaginally born children, it appears possible that cesarean delivery may have a convincingly adverse effect on children’s further cognitive development.

Effect of Polycyclic Aromatic Hydrocarbons Exposure on Cognitive Development in 5 Years Old Children.

Objectives: To analyze the impact of polycyclic aromatic hydrocarbons (PAHs) in ambient air at the time of delivery and five years of age on cognitive development in five year old children. Materials and Methods: Two cohorts of children born in the years 2013 and 2014 from Karvina (Northern Moravia, n = 70) and Ceske Budejovice (Southern Bohemia, n = 99) were studied at the age of five years for their cognitive development related to the exposure to PAHs, determined in the ambient air as the concentration of benzo[a]pyrene (B[a]P) and OH–PAH (hydroxy-PAH) metabolites in urine of the newborns at the time of delivery. As psychological tests, the Bender Visual Motor Gestalt Test (BG test) and the Raven Colored Progressive Matrices (RCPM test) were used. Results: Concentrations of B[a]P in the third trimester of mother’s pregnancies were 6.1 ± 4.53 ng/m3 in Karvina, and 1.19 ± 1.28 ng/m3 (p < 0.001) in Ceske Budejovice. Neither the outcome of the RCPM test nor the BG test differed between children in Karvina vs. Ceske Budejovice, or boys vs. girls. Cognitive development in five year old children was affected by the higher exposure to PM2.5 during the third trimester in girls in Karvina. Conclusions: We did not observe any significant effect of prenatal PAH exposure on psychological cognitive tests in five year old children.

279. Evaluation of β-d-Glucan Utilization in Thailand: Single Academic Center Experience

Backgroundβ-d-glucan (BG) detection was first available in Thailand in 2016 to aid diagnosis of invasive fungal infections (IFIs). Given a paucity of real-world experience of BG use in resource-limited countries, this study was conducted to describe appropriateness of BG testing and sequelae of BG results.MethodsA retrospective study included all patients with at least 1 BG ordered at King Chulalongkorn Memorial Hospital, Bangkok, Thailand during March 2016 to December 2018. Descriptive statistics were used.Results83 patients were tested by BG assay (Fungitell, Associates of Cape Cod, Inc.): 6 with hematopoietic stem cell transplant, 12 with solid-organ transplant, 20 with active cancer receiving chemotherapy, 34 receiving high dose steroids (≥20 mg/day of prednisone for ≥3 weeks) and 11 with other conditions. Seventy-three patients were tested under infectious disease (ID) service’s recommendations. There were 13 and 20 cases of proven and probable IFIs, respectively. Among 13 proven IFIs, there were 11 positive, 1 indeterminate and 1 negative (mucormycosis) BG results. Among 49 cases with positive BG results, 24 were determined to be false-positive results. Median turn-around time for BG results was 16 (IQR: 9–23) days. Due to high turn-around time, only 8 patients were started on antifungal agent(s) and 3 underwent bronchoscopy due to positive BG results. All proven IFI cases were started on antifungal treatment prior to BG availability.ConclusionApproximately 87% of BG use in Thailand was ordered in patients with risk factors for IFIs. This could be due to majority of BG test was recommended by ID specialist. Despite being used in right clinical context, 49% had false-positive BG results. Another barrier of BG use in Thailand was high turn-around time due to small numbers of BG ordered and relative high cost to run the assay. Therefore, the utility of BG for aiding diagnosis or management of fungal infection in our setting is limited.Disclosures All authors: No reported disclosures.

A Single Dose of Baicalin Has No Clinically Significant Effect on the Pharmacokinetics of Cyclosporine A in Healthy Chinese Volunteers.

Despite its narrow therapeutic window and large interindividual variability, cyclosporine A (CsA) is the first-line therapy following organ transplantation. Metabolized mainly by CYP3A and being a substrate of P-glycoprotein (P-gp), CsA is susceptible to drug–drug interactions. Baicalin (BG) is a drug used for adjuvant therapy of hepatitis in traditional Chinese medicine. Since its aglycone baicalein (B) inhibits CYP3A and P-gP, co-administration might affect CsA pharmacokinetics. This study investigated the effect of BG on CsA pharmacokinetics. In a two-period study, 16 healthy volunteers received a single 200 mg oral CsA dose alone (reference period) or in combination with 500 mg BG (test period). Pharmacokinetic evaluation of CsA was carried out using non-compartmental analysis (NCA) and population pharmacokinetics (popPK). Treatments were compared using the standard bioequivalence method. Based on NCA, 90% CIs of AUC and Cmax test-to-reference ratios were within bioequivalence boundaries. In the popPK analysis, a two-compartment model (clearance/F 62.8 L/h, central and peripheral volume of distribution/F 254 L and 388 L) with transit compartments for absorption appropriately described CsA concentrations. No clinically relevant effect of 500 mg BG co-administration on CsA pharmacokinetics was identified and both treatments were well tolerated.

Diagnostic accuracy of the 1,3-β-D-glucan test for pneumocystis pneumonia in a tertiary university hospital in Denmark: A retrospective study.

1,3-β-D-glucan (BG), a cell-wall component of most fungi including Pneumocystis (PC), is recommended by international guidelines for screening for pneumocystis pneumonia (PCP) in hematologic patients. We retrospectively validated the BG test in our tertiary university hospital. Forty-five patients (median age 53 years, 33% female) tested for PC by polymerase chain reaction (PCR) and/or immunoflourescence (IF)-microscopy with a stored blood sample within ±5 days of the PC test were tested by the Fungitell (cutoff <60 and >80 pg/ml). Cases had symptoms and radiology compatible with PCP and positive IF-microscopy (proven PCP, n = 8) or positive PCR (probable PCP, n = 10). Controls had no compatible symptoms/radiology and negative tests for PC on conventional testing (no PCP, n = 24), or positive PCR/IF-microscopy (colonized, n = 3). Median BG-levels were 1108 pg/ml (proven PCP), 612 pg/ml (probable PCP), 29 pg/ml (colonized), and 48 pg/ml (controls, P < 0.001). Compared to the PCP case/control classification, the BG test showed sensitivities of 83-89% and specificities of 64-74%, positive likelihood ratio (LR) of 3.2 and negative LR of 0.23 at recommended cutoff and moderate agreement between tests. Optimal cutoff was ≥73 pg/ml. In PCR-positive cases, the agreement between the BG test and IF-microscopy was 78-89% with fair/moderate agreement. Elevated BG levels were seen in controls with probable invasive fungal infections (n = 4), hemodialysis, bacterial infections and/or betalactams. To conclude, 11% of patients with PCP would be missed if the BG test had been used for diagnosing PCP. Specificity was moderate. Among PCR-positive patients, the BG test identified more cases than IF-microscopy. BG testing is potentially helpful but sensitivity is insufficient to exclude PCP.

Cost Savings Associated with Usage and Blood Glucose Control for Members of the Livongo for Diabetes Program

Background: Novel technologies to support real-time self-management of chronic conditions are of interest to entities bearing financial risk for healthcare costs. The Livongo Diabetes Program offers patients with diabetes (1) a cellular-enabled, two-way messaging device that measures blood glucose, (2) free unlimited BG test strips; and (3) access to Certified Diabetes Educators for real-time support and goal setting. Previous work has shown decreased medical costs of $83pmpm for Livongo members vs. matched controls during first year of program. This study uses biometric and claims data to investigate the association between use of the Livongo program, BG control and medical spending among a commercially insured population of diabetes patients. Methods: We compared medical spending and clinical outcomes for Livongo users (n =2027) with matched non-Livongo users (n=8385) for 12 months before and after the launch of the Livongo program using multivariate instrumental variable regression models that included controls for patient demographics (e.g., age, gender) and risk characteristics (e.g., comorbidity index, prior-period medical spending and program usage). Results: Following launch of Livongo, risk-adjusted total spending for users and non-users decreased by 15.9%. Launch of Livongo led to a risk-adjusted 76.2% increase in the monthly use rate of Livongo. A 10% increase in the monthly Livongo usage rate is associated with a 2.1% decrease in medical spending associated (p&amp;lt;0.01), which was driven by a 2.9% reduction in spending on office-based services. Mean monthly medical spending for users with mean BG&amp;lt;154mg/dL was significantly lower than for users with mean BG&amp;gt;154mg/dL ($505.86 vs. $681.01, p=0.02). Conclusion: Patients with diabetes enrolled in the Livongo program for 12 months experience medical cost savings associated with improved BG control. Cost savings for Livongo program users are primarily due to decreased spending on outpatient visits. Disclosure J. Bollyky: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health. W. Lu: None. J. Schneider: Employee; Self; Livongo Health. Stock/Shareholder; Self; Livongo Health. C. Whaley: Consultant; Self; Livongo Health.

Detection of (1,3)-β-d-Glucan for the Diagnosis of Invasive Fungal Infection in Liver Transplant Recipients.

Invasive fungal infections (IFI) are complications after liver transplantation involving high morbidity and mortality. (1,3)-β-d-glucan (BG) is a biomarker for IFI, but its utility remains uncertain. This study was designed to evaluate the impact of BG following their diagnosis. Between January 2013 and May 2016, 271 liver transplants were performed in our institution. Serum samples were tested for BG (Fungitell®, Associates Cape Code Inc., Falmouth, MA, USA) at least weekly between liver transplantation and the discharge of patients. Nineteen patients (7%) were diagnosed with IFI, including 13 cases of invasive candidiasis (IC), eight cases of invasive pulmonary aspergillosis, and one case of septic arthritis due to Scedosporium apiospernum. Using a single BG sample for the primary analysis of IFI, 95% (21/22) of the subjects had positive BG (>80 pg/mL) at the time of IFI diagnosis. The area under the ROC curves to predict IFI was 0.78 (95% CI: 0.73–0.83). The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of BG for IFI were 75% (95% CI: 65–83), 65% (62–68), 17% (13–21), and 96% (94–97), respectively. Based on their high NPV, the BG test appears to constitute a good biomarker to rule out a diagnosis of IFI.

Robust Dickey–Fuller tests based on ranks for time series with additive outliers

In this paper the unit root tests proposed by Dickey and Fuller (DF) and their rank counterpart suggested by Breitung and Gourieroux (J Econom 81(1): 7–27, 1997) (BG) are analytically investigated under the presence of additive outlier (AO) contaminations. The results show that the limiting distribution of the former test is outlier dependent, while the latter one is outlier free. The finite sample size properties of these tests are also investigated under different scenarios of testing contaminated unit root processes. In the empirical study, the alternative DF rank test suggested in Granger and Hallman (J Time Ser Anal 12(3): 207–224, 1991) (GH) is also considered. In Fotopoulos and Ahn (J Time Ser Anal 24(6): 647–662, 2003), these unit root rank tests were analytically and empirically investigated and compared to the DF test, but with outlier-free processes. Thus, the results provided in this paper complement the studies of the previous works, but in the context of time series with additive outliers. Equivalently to DF and Granger and Hallman (J Time Ser Anal 12(3): 207–224, 1991) unit root tests, the BG test shows to be sensitive to AO contaminations, but with less severity. In practical situations where there would be a suspicion of additive outlier, the general conclusion is that the DF and Granger and Hallman (J Time Ser Anal 12(3): 207–224, 1991) unit root tests should be avoided, however, the BG approach can still be used.

Probable glucometer interference caused by topical iodine solution test site preparation

Use of disinfectants, such as alcohol prep pads, for test site preparation have demonstrated alterations in glucose readings. One case report details an overestimation of blood glucose (BG) readings when using Chemstrip bG and Visidex reagent test strips after cleaning test site with povidone-iodine swabs We present a case of a clinically relevant probable drug-device interaction between topical iodine and a point-of-care glucometer in a 28 year old pregnant woman of Chinese descent. In this case, the use of 10% povidone-iodine solution on the testing site before lancing likely resulted in variable and inaccurate BG readings, which was not reproduced when the patient used hand washing instead of iodine. Our report expands on this prior knowledge by demonstrating that such an alteration associated with iodine can occur with modern electrochemical glucometers. In patients that have aberrant or variable BG readings, providers should investigate for improper testing technique.

(1, 3)-β-D-glucan assay for diagnosing invasive fungal infections in critically ill patients with hematological malignancies.

Invasive fungal infections (IFIs) are life-threatening complications of hematological malignancies that must be diagnosed early to allow effective treatment. Few data are available on the performance of serum (1–3)-β-D-glucan (BG) assays for diagnosing IFI in patients with hematological malignancies admitted to the intensive care unit (ICU). In this study, 737 consecutive patients with hematological malignancies admitted to 17 ICUs routinely underwent a BG assay at ICU admission. IFIs were diagnosed using standard criteria applied by three independent specialists. Among the 737 patients, 439 (60%) required mechanical ventilation and 273 (37%) died before hospital discharge. Factors known to alter BG concentrations were identified in most patients. IFIs were documented in 78 (10.6%) patients (invasive pulmonary aspergillosis, n = 54; Pneumocystis jirovecii pneumonia, n = 13; candidemia, n = 13; and fusarium infections, n = 3). BG concentrations (pg/mL) were higher in patients with than without IFI (144 (77–510) vs. 50 (30–125), < 0.0001). With 80 pg/mL as the cutoff, sensitivity was 72%, specificity 65%, and area-under-the-curve 0.74 (0.68–0.79). Assuming a prevalence of 10%, the negative and positive predictive values were 94% and 21%. By multivariable analysis, factors independently associated with BG > 80 pg/mL were IFI, admission SOFA score, autologous bone-marrow or hematopoietic stem-cell transplantation, and microbiologically documented bacterial infection. In conclusion, in unselected critically ill hematology patients with factors known to affect serum BG, this biomarker showed only moderate diagnostic performance and rarely detected IFI. However, the negative predictive value was high. Studies are needed to assess whether a negative BG test indicates that antifungal de-escalation is safe.

5thAnnual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond, May 3–5, 2012, Dublin, Ireland

International experts in the fields of diabetes, diabetes technology, endocrinology, and pediatrics gathered for the 5th Annual Symposium on Self-Monitoring of Blood Glucose (SMBG) Applications and Beyond. The aim of this meeting was to continue setting up a global network of experts in this field and provide an international platform for exchange of ideas to improve life for people with diabetes. In line with previous editions, the 2012 meeting comprised a comprehensive scientific program, parallel interactive workshops, pros and cons debates, and a keynote. All these discussions were intended to help identifying gaps and areas where further scientific work and clinical studies are needed.

Development and evaluation of a pilot one-stop workshop for young adult people with type 1 diabetes

<h3>Aims</h3> Here, we describe the development and piloting of a community-based workshop in adolescents with type 1 diabetes. From the service evaluation perspective, the aim was to evaluate the feasibility of the workshop as a mode of delivery of health care information. For participants, we aimed not only to increase awareness of healthcare needs by enhancing their knowledge related to the aspects of diabetes management, but also to engage them in discussions in a community and group based setting. <h3>Method</h3> We approached 174 patients identified from our clinical database, aged 15-20, using an assessment form (AF) to determine interest in attending a workshop and asking about specific topics of interest which were then incorporated into the designed programme. 44 AF were received back and invitation letters and a timetable then sent to 17 participants interested in attending, with 7 attending the workshop. Importantly, an integrative approach was utilised by involving the broad multidisciplinary adult and paediatric clinical teams in this programme, which dealt with medical, psychological and social aspects of diabetes management and was delivered using a variety of interactive tools. Within 8 weeks of the workshop, feedback was obtained using a structured outcome evaluation. <h3>Results</h3> In summary, the outcome evaluation suggested that the workshop improved communication with health care professional, promoted more frequent BG testing and improved skills of carbohydrate counting and physical activity. Specifically, most participants reported enjoying the workshop (86%), learning about diabetes management (58%) and the ability to prioritise health care needs (72%). Most also reported improved confidence to communicate with peers (72%) and health care staff (72%). 57% said that they will now monitor blood glucose more frequently. When asked about workshop format, 44% suggested they would prefer the future workshops in a community setting and 57% suggested 2-3 hour duration. <h3>Conclusion</h3> This workshop demonstrated a potentially feasible, effective and optimal method to deliver group based education in a community setting for young adults with type 1 diabetes focusing upon patient-centred approach. Participants appreciated the idea of attending the workshop with their peers and found it beneficial to learn about diabetes in a group setting.

Clinical Performance of the (1,3)-β- d -Glucan Assay in Early Diagnosis of Nosocomial Candida Bloodstream Infections

Microbiological diagnosis of nosocomial candidemia is negatively affected by suboptimal culture yield. Alternative methods are not fully reliable as an aid in candidemia diagnosis. Recently, the detection of (1,3)-β-D-glucan (BG) has been shown to be very promising in this setting. We carried out a prospective study on the clinical usefulness of BG detection in early diagnosis of candidemia. BG detection was performed in patients with fever unresponsive to antibacterial agents and risk factors for candidemia. BG detection was done with the Fungitell test. A total of 152 patients were included in the study; 53 were proven to have candidemia, while in 52 patients candidemia was excluded on microbiological and clinical bases. The remaining 47 patients were considered to have possible candidemia. In summary, 41 of 53 candidemia patients (77.3%), 9 of 52 patients without candidemia (17.3%), and 38 of 47 patients with possible candidemia (80.8%) were positive in the BG assay. With these results, the sensitivity and the specificity of the assay were 77% and 83%, respectively. BG levels of >160 pg/ml were highly predictive of candidemia. In 36 of 41 patients with candidemia and positive BG testing, the BG assay was performed within 48 h from when the first Candida-positive blood sample for culture was drawn, thus allowing a possible earlier start of antifungal therapy. Based on these results, the BG assay may be used as an aid in the diagnosis of nosocomial candidemia. The timing of assay performance is critical for collecting clinically useful information. However, the test results should be associated with clinical data.