Gestandaardiseerde berekeningsmethode voor dierlijke mest en mineralen : standaardcijfers 1990-2008

Vanaf het begin van de jaren negentig stelt de Werkgroep Uniformering berekening Mesten mineralencijfers (WUM) jaarlijks standaardfactoren vast voor de mestproductie en mineralenuitscheiding per diercategorie. Dit rapport geeft een overzicht van de rekenmethodiek en de uitgangspunten die door de werkgroep zijn toegepast. In 2009 is op verzoek van de Emissieregistratie een herberekening uitgevoerd voor de periode 1990–2006. In de herberekening zijn zoveel mogelijk nieuwe inzichten en tevens een aantal correcties verwerkt. In het voorliggende rapport worden alleen de actuele uitgangspunten voor de periode 1990 tot heden beschreven

Unmasking Individual and Institutional HIV Stigma in Hospitals:Perspectives of Dutch Healthcare Providers

People with HIV continue to experience HIV stigma. Quantitative data on HIV stigma perpetrated by healthcare providers of hospitals providing HIV care in high-income countries are limited. The aim of this study is to investigate factors associated with HIV stigma in Dutch healthcare settings from the healthcare providers’ perspective. We conducted a cross-sectional study using the questionnaire ‘Measuring HIV Stigma and Discrimination Among Health Facility Staff – Monitoring Tool for Global Indicators’ to assess HIV stigma among healthcare providers (n = 405) in two academic hospitals. Healthcare providers licensed to provide medical care were eligible for inclusion. The primary outcome was the self-reported prevalence of at least one manifestation of HIV stigma measured by six stigma indicators (four individual, two institutional). Secondary outcomes were the prevalence of HIV stigma per indicator, per occupation, per department, and factors associated with individual stigma indicators. HIV stigma was prevalent among 88.1% (95%CI 84.5% − 91.2%) of participants. Stigma was mostly driven by negative attitudes towards people with HIV and worry to acquire HIV. Multivariate analysis showed that several factors were associated with HIV stigma, including younger age, male sex, working at one of the surgical departments, and working as a nurse. Having received any training on HIV stigma and/or discrimination was associated with less HIV stigma among all indicators. In conclusion, HIV stigma is highly prevalent among Dutch healthcare providers. Targeted approaches, including training on HIV stigma and discrimination, are needed to reduce HIV stigma in healthcare and should, among others, focus on younger healthcare providers.</p

Methodology for estimating emissions from agriculture in the Netherlands : Calculations of CH4, NH3, N2O, NOx, NMVOC, PM10, PM2.5 and CO2 with the National Emission Model for Agriculture (NEMA), Update 2019

The National Emission Model for Agriculture (NEMA) is used to calculate emissions to air from agricultural activities in the Netherlands on a national scale. Emissions of ammonia (NH3) and other N compounds (NOx and N2O) are calculated for animal housing, manure storage, manure application and grazing using a flow model for total ammoniacal nitrogen (TAN). Emissions from the application of inorganic N fertilizer, compost and sewage sludge, cultivation of organic soils, crop residues, and ripening of crops are calculated as well. The NEMA is also used to estimate emissions of methane (CH4) from enteric fermentation and manure management, nonmethane volatile organic compounds (NMVOC) and particulate matter (PM) from manure management and agricultural soils, as well as for carbon dioxide (CO2) from liming. Emissions are calculated in accordance with the criteria of international guidelines and reported in an annual Informative Inventory Report (IIR; for air pollutants) and National Inventory Report (NIR; for greenhouse gases). This methodology report provides an outline of and describes the background to the calculation of emissions according to the NEMA

The effect of taurolidine on the time-to-positivity of blood cultures

Background: Taurolidine containing lock solutions (TL) are a promising method for the prevention of central line associated bloodstream infections. Per accident, the TL may not always be aspirated from the central venous catheter (CVC) before blood cultures are obtained. The TL could, unintentionally, end up in a blood culture vial, possibly altering the results. The aim of this study was to investigate the effect of the TLs on the detection of microbial growth in blood culture vials. Methods: Different lock solutions (taurolidine-citrate-heparin (TCHL), taurolidine, heparin, citrate or NaCl) were added to BD BACTECTM blood culture vials (Plus Aerobic/F, Lytic/10 Anaerobic/F or Peds Plus/F) before spiking with Staphylococcus aureus (ATCC 29213 or a clinical strain) or Escherichia coli (ATCC 25922 or a clinical strain) in the presence and absence of blood. Subsequently, blood culture vials were incubated in the BD BACTEC FX instrument with Time-to-positivity (TTP) as primary outcome. In addition, the effect of the TCHL on a variety of other micro-organisms was tested. Discussion: In the presence of taurolidine, the TTP was considerably delayed or vials even remained negative as compared to vials containing heparin, citrate or NaCl. This effect was dose-dependent. The delayed TTP was much less pronounced in the presence of blood, but still notable. Conclusion: This study stresses the clinical importance of discarding TLs from the CVC before obtaining a blood culture

Emissies naar lucht uit de landbouw in 2016 : Berekeningen met het model NEMA

Agricultural activities are in the Netherlands a major source of ammonia (NH3), nitrogen oxide (NO), nitrous oxide (N2O), methane (CH4) and particulate matter (PM10 and PM2.5). The emissions in 2016 were calculated using the National Emission Model for Agriculture (NEMA). Some figures in the time series 1990-2015 were revised. The method calculates the NH3 emission from livestock manure based on the total ammonia nitrogen (TAN) content in manure. In 2016 NH3 emissions from livestock manure, fertilizer and other sources in agriculture, from hobby farms, private parties and manure disposal in nature areas amounted to 116.8 million kg NH3, 1.3 million kg more than in 2015. Nitrogen excretion increased due to expansion of the dairy herd, but because of a larger share of low emission housing and more manure exports outside agriculture, the increase in NH3 emission remained limited. N2O emissions in 2016 were 21.1 million kg at virtually the same level as in 2015(21.2). NO emissions in 2016 totaled 22.8 million kg compared to 22.6 million kg in 2015. CH4 emissions increased from 496 to512 million kg due to the expansion of the dairy herd. Emissions of particulate matter PM10 and PM2.5, 6.5 and 0.6 million kg respectively, did not change compared to 2015. NH3 emissions from livestock manure in the Netherlands dropped by almost two thirds since 1990, mainly as a result of lower nitrogen excretion rates by livestock and low emission manure application. Emissions of N2O and NO also decreased over the same period, but less strongly (38% and 31% respectively), due to higher emissions from manure injection into the soil and the shift from poultry housing systems with liquid manure towards solid manure systems. CH4 emissions reduced by 13% between 1990 and 2016 caused by a decrease in livestock numbers and increased feed efficiency of dairy cattle

Unique Roles of Mothering and Fathering in Child Anxiety; Moderation by Child’s Age and Gender

We examined the associations between the parenting dimensions autonomy granting, over control, and rejection and children’s anxiety, in relation to parent and child gender and child age. Elementary school-aged children (n = 179, Mage = 10.27, SD = 1.30), adolescents (n = 127, Mage = 15.02, SD = 1.54) and both their parents completed questionnaires on parenting and children’s anxiety. Parenting was more strongly related to child anxiety in elementary school children than in adolescents. Maternal over control was uniquely related to elementary school-aged children’s anxiety whereas paternal over control was more important during adolescence. Opposite to our expectations, we found higher levels of parental autonomy granting to be related to higher levels of anxiety for younger elementary school-aged children (age < 10). For adolescents, the association between paternal over control and anxiety was stronger for older adolescents (age > 15), with higher levels of over control related to higher levels of anxiety. For both elementary school-aged children and adolescents, the associations between parenting and child anxiety did not differ as a function of the child’s gender. If we are to understand the associations between parenting and children’s anxiety, it is important to distinguish parental autonomy granting from parental over control and to consider the role of parent gender and the age of the child

The CATERPILLAR-study: An assessor blinded randomized controlled trial comparing a taurolidine-citrate-heparin lock solution to a heparin-only lock solution for the prevention of central-line associated bloodstream infections in paediatric oncology patients

Background: Taurolidine–citrate(–heparin) lock solutions (TCHL) are suggested as a promising and safe method for the prevention of central-line-associated bloodstream infections (CLABSI). Aim: To investigate the efficacy of TCHL for the prevention of CLABSI in paediatric oncology patients. Methods: An assessor-blinded randomized controlled trial at the Princess Máxima Centre for paediatric oncology, the Netherlands, was performed from 2020 to 2023. Paediatric oncology patients receiving a tunnelled central venous access device (CVAD) were eligible. A total of 462 patients were required to compare the TCHL to the heparin-only lock (HL). Patients were followed-up for the first 90 days after CVAD insertion. The primary outcome was the incidence of the first CLABSI from CVAD insertion until the end of follow-up. Intention-to-treat and per-protocol analyses were performed. Findings: In total, 232 were randomized in the HL and 231 in the TCHL group. A total of 47 CLABSIs were observed. The intention-to-treat analysis showed that a CLABSI was observed in 26 (11.2%) of the HL group patients versus 21 (9.1%) of the TCHL group patients; incidence rate ratio (IRR) of 0.81 (95% confidence interval (CI): 0.46–1.45) in favour of the TCHL group. The per-protocol analysis showed that a CLABSI was observed in 10 (7.9%) of the HL group patients versus 6 (4.8%) of the TCHL group patients; IRR of 0.59 (95% CI: 0.21–1.62) in favour of the TCHL group. Adverse events were more common in the TCHL group but rarely reported. Conclusion: No difference was detected between the TCHL and HL in the incidence of CLABSI in paediatric oncology patients

Emissies naar lucht uit de landbouw in 2014 : berekeningen met het model NEMA

Landbouwkundige activiteiten zijn in Nederland een belangrijke bron van ammoniak (NH3), stikstofoxide (NO), lachgas (N2O),methaan (CH4) en fijnstof (PM10 en PM2,5). De emissies in 2014 zijn berekend met het National Emission Model for Agriculture(NEMA). Tegelijk zijn enkele cijfers in de reeks 1990-2013 aangepast op basis van nieuwe inzichten. De rekenmethodiek gaatbij de berekening van de ammoniakemissie uit dierlijke mest uit van de hoeveelheid totaal ammoniakaal stikstof (TAN) in demest. De ammoniakemissie uit dierlijke mest, kunstmest en overige bronnen in 2014 bedroeg 121 miljoen kg NH3, bijna4 miljoen kg meer dan in 2013. De stijging komt voornamelijk door uitbreiding van de melkveestapel en een hogerstikstofgehalte van het ruwvoer. De N2O-emissie nam toe van 19,1 miljoen kg in 2013 naar 19,4 miljoen kg in 2014. De NOemissienam toe van 16,9 naar 17,2 miljoen kg. De methaanemissie nam iets toe van 499 tot 503 miljoen kg. De emissie vanfijnstof nam licht toe van 6,3 miljoen kg PM10 tot 6,4 miljoen kg, door een toename van het aantal stuks pluimvee. De emissievan PM2,5 bedroeg in beide jaren 0,6 miljoen kg. Sinds 1990 is de ammoniakemissie uit dierlijke mest en kunstmest mettweederde gedaald, vooral door een lagere stikstofuitscheiding door landbouwhuisdieren en emissiearme mesttoediening.Emissies van lachgas en stikstofoxide daalden in dezelfde periode eveneens, maar minder sterk (ca. 40%) omdat doorondergronds toedienen van mest de emissies hoger zijn geworden en door de omschakeling van stalsystemen met dunne naarvaste mest bij pluimvee. Tussen 1990 en 2014 daalde de emissie van methaan met 16% door een afname in de dieraantallenen een hogere voeropname en productiviteit van melkvee---Agricultural activities are in the Netherlands a major source of ammonia (NH3), nitrogen oxide (NO), nitrous oxide (N2O),methane (CH4) and particulate matter (PM10 and PM2.5). The emissions in 2014 were calculated using the National EmissionModel for Agriculture (NEMA). At the same time some figures in the time series 1990-2013 were revised. The method calculatesthe ammonia emission from livestock manure on the basis of the total ammonia nitrogen (TAN) content in manure. Ammoniaemissions from livestock manure, fertilizers and other sources in 2014 were 121 million kg, which was almost 4 million kghigher than in 2013, mainly due to expansion of the dairy herd and a higher N-content of roughage. N2O emissions increasedfrom 19.1 million kg in 2013 to 19.4 million kg in 2014. NO emission increased slightly from 16.9 to 17.2 million kg. Methaneemissions increased from 499 to 503 million kg. Emissions of particulate matter increased slightly from 6.3 to 6.4 million kgPM10 as a result of higher poultry numbers. Emission of PM2.5 in both years was 0.6 million kg. Ammonia emissions fromlivestock manure in the Netherlands dropped by almost two thirds since 1990, mainly as a result of lower nitrogen excretionrates by livestock and low-emission manure application. Nitrous oxide and nitrogen oxide also fell over the same period, butless steeply (by about 40%), due to higher emissions from manure injection into the soil and to the shift from poultry housingsystems based on liquid manure to solid manure systems. Methane emissions fell by 16% between 1990 and 2014 caused by adrop in livestock numbers and increased feed uptake and productivity of dairy cattl

Clostridioides difficile infection with isolates of cryptic clade C-II: a genomic analysis of polymerase chain reaction ribotype 151

Objectives: We report a patient case of pseudomembranous colitis associated with a monotoxinproducing Clostridioides difficile belonging to the very rarely diagnosed polymerase chain reaction (PCR) ribotype (RT) 151. To understand why this isolate was not identified using a routine commercial test, we performed a genomic analysis of RT151. Methods: Illumina short-read sequencing was performed on n = 11 RT151s from various geographical regions to study their genomic characteristics and relatedness. Subsequently, we used PacBio circular consensus sequencing to determine the complete genome sequence of isolates belonging to cryptic clades CeI and C-II, which includes the patient isolate. Results: We found that 1) RT151s are polyphyletic with isolates falling into clades 1 and cryptic clades C eI and C-II; 2) RT151 contains both nontoxigenic and toxigenic isolates and 3) RT151 C-II isolates contained monotoxin pathogenicity loci. The isolate from our patient case report contains a novelpathogenicity loci insertion site, lacked tcdA and had a divergent tcdB sequence that might explain the failure of the diagnostic test. Discussion: This study shows that RT151 encompasses both typical and cryptic clades and provides conclusive evidence for C. difficile infection due to clade C-II isolates that was hitherto lacking. Vigilance towards C. difficile infection as a result of cryptic clade isolates is warranted. Quinten R. Ducarmon, Clin Microbiol Infect 2023;29:538.e1-538.e6 (c) 2022 The Author(s). Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases. This is an open access article under the CC BY-NC-ND license (http:// creativecommons.org/licenses/by-nc-nd/4.0/).Molecular basis of bacterial pathogenesis, virulence factors and antibiotic resistanc