Optimizing infectious disease control:how to detect hidden infections?

The studies in this dissertation aim to identify hidden infections and evaluate the prevention, surveillance and infectious disease control policies currently in place. This is illustrated with studies on pertussis and hepatitis. Several methods are used to identify hidden infections. This dissertation reveals that the notification period is a valuable tool to identify the different levels and influential factors involved in combating infectious diseases. Epidemiological and geographical analyses help to identify high-risk groups and estimate the prevalence of hidden infections. However, there is no one-size-fits-all approach to all infectious diseases. This dissertation also demonstrates the importance of testing models and estimates in practice. The results were shared with general practitioners, laboratories, health institutes and the Netherlands' National Institute for Public Health (RIVM). Our recommendations were included in the national guideline drafted by the Health Council and were applied in practice

Participation, retention, and associated factors of women in a prospective multicenter study on Chlamydia trachomatis infections (FemCure)

Prospective studies are key study designs when attempting to unravel health mechanisms that are widely applicable. Understanding the internal validity of a prospective study is essential to judge a study's quality. Moreover, insights in possible sampling bias and the external validity of a prospective study are useful to judge the applicability of a study's findings. We evaluated participation, retention, and associated factors of women in a multicenter prospective cohort (FemCure) to understand the study's validity.Chlamydia trachomatis (CT) infected adult women, negative for HIV, syphilis, and Neisseria gonorrhoeae were eligible to be preselected and included at three sexually transmitted infection (STI) clinics in the Netherlands (2016-2017). The planned follow-up for participants was 3 months, with two weekly rectal and vaginal CT self-sampling and online questionnaires administered at home and at the clinic. We calculated the proportions of preselected, included, and retained (completed follow-up) women. Associations with non-preselection, noninclusion, and non-retention (called attrition) were assessed (logistic and Cox regression).Among the 4,916 women, 1,763 (35.9%) were preselected, of whom 560 (31.8%) were included. The study population had diverse baseline characteristics: study site, migration background, high education, and no STI history were associated with non-preselection and noninclusion. Retention was 76.3% (n = 427). Attrition was 10.71/100 person/month (95% confidence interval 9.97, 12.69) and was associated with young age and low education. In an outpatient clinical setting, it proved feasible to include and retain women in an intensive prospective cohort. External validity was limited as the study population was not representative (sampling bias), but this did not affect the internal validity. Selective attrition, however (potential selection bias), should be accounted for when interpreting the study results

Divergent Chemical Cues Elicit Seed Collecting by Ants in an Obligate Multi-Species Mutualism in Lowland Amazonia

In lowland Amazonian rainforests, specific ants collect seeds of several plant species and cultivate them in arboreal carton nests, forming species-specific symbioses called ant-gardens (AGs). In this obligate mutualism, ants depend on the plants for nest stability and the plants depend on ant nests for substrate and nutrients. AG ants and plants are abundant, dominant members of lowland Amazonian ecosystems, but the cues ants use to recognize the seeds are poorly understood. To address the chemical basis of the ant-seed interaction, we surveyed seed chemistry in nine AG species and eight non-AG congeners. We detected seven phenolic and terpenoid volatiles common to seeds of all or most of the AG species, but a blend of the shared compounds was not attractive to the AG ant Camponotus femoratus. We also analyzed seeds of three AG species (Anthurium gracile, Codonanthe uleana, and Peperomia macrostachya) using behavior-guided fractionation. At least one chromatographic fraction of each seed extract elicited retrieval behavior in C. femoratus, but the active fractions of the three plant species differed in polarity and chemical composition, indicating that shared compounds alone did not explain seed-carrying behavior. We suggest that the various AG seed species must elicit seed-carrying with different chemical cues

Uncertainties and controversies in axillary management of patients with breast cancer

The aims of this Oncoplastic Breast Consortium and European Breast Cancer Research Association of Surgical Trialists initiative were to identify uncertainties and controversies in axillary management of early breast cancer and to recommend appropriate strategies to address them. By use of Delphi methods, 15 questions were prioritized by more than 250 breast surgeons, patient advocates and radiation oncologists from 60 countries. Subsequently, a global virtual consensus panel considered available data, ongoing studies and resource utilization. It agreed that research should no longer be prioritized for standardization of axillary imaging, de-escalation of axillary surgery in node-positive cancer and risk evaluation of modern surgery and radiotherapy. Instead, expert consensus recommendations for clinical practice should be based on current evidence and updated once results from ongoing studies become available. Research on de-escalation of radiotherapy and identification of the most relevant endpoints in axillary management should encompass a meta-analysis to identify knowledge gaps, followed by a Delphi process to prioritize and a consensus conference to refine recommendations for specific trial designs. Finally, treatment of residual nodal disease after surgery was recommended to be assessed in a prospective register

Oncoplastic breast consortium recommendations for mastectomy and whole breast reconstruction in the setting of post-mastectomy radiation therapy

Aim: Demand for nipple-and skin-sparing mastectomy (NSM/SSM) with immediate breast reconstruction (BR) has increased at the same time as indications for post-mastectomy radiation therapy (PMRT) have broadened. The aim of the Oncoplastic Breast Consortium initiative was to address relevant questions arising with this clinically challenging scenario. Methods: A large global panel of oncologic, oncoplastic and reconstructive breast surgeons, patient advocates and radiation oncologists developed recommendations for clinical practice in an iterative process based on the principles of Delphi methodology. Results: The panel agreed that surgical technique for NSM/SSM should not be formally modified when PMRT is planned with preference for autologous over implant-based BR due to lower risk of long-term complications and support for immediate and delayed-immediate reconstructive approaches. Nevertheless, it was strongly believed that PMRT is not an absolute contraindication for implant-based or other types of BR, but no specific recom-mendations regarding implant positioning, use of mesh or timing were made due to absence of high-quality evidence. The panel endorsed use of patient-reported outcomes in clinical practice. It was acknowledged that the shape and size of reconstructed breasts can hinder radiotherapy planning and attention to details of PMRT techniques is important in determining aesthetic outcomes after immediate BR. Conclusions: The panel endorsed the need for prospective, ideally randomised phase III studies and for surgical and radiation oncology teams to work together for determination of optimal sequencing and techniques for PMRT for each patient in the context of BRPeer reviewe

Why Is There No Raising to Object in Spanish? A Study of Code-Switching

Raising to Object (RtoObj), like other types of Raising configurations, features a determiner phrase (DP) in a dual-clausal relationship with both the matrix and the embedded clauses. RtoO is possible in English and a few other languages, most famously, Icelandic. However, it is not possible in many other languages, such as Spanish. As far as we can tell, insight into what licenses RtoObj is largely speculative. The main goal of this paper is to limit the range of possible hypotheses by pinpointing the source of the cross-linguistic difference using code-switching data. A priori, we could hypothesize two possible sources for the licensor of RtoObj: it could be a feature in the matrix clause or a feature in the infinitival complement. In this chapter, we present code-switching data that support the second option: English TdefP is linked to the licensing of RtoObj. We find that early Spanish/English bilinguals overwhelmingly prefer code-switched RtoObj samples when the infinitival complement is in English and they reject RtoObj when the complement is a Spanish infinitival. This suggests that Spanish Tdef is either different or altogether missing

Extra-syntactic factors in the that-trace effect

Chapter 14 in Contemporary Trends in Hispanic and Lusophone Linguistics: Selected papers from the Hispanic Linguistic Symposium 2015, edited by Jonathan E. MacDonald. Chapter description: Using predictions from the Interface Hypothesis and the grammar of Spanish-English bilinguals, we test whether non-syntactic factors play a role in the that-trace effect. Though generally analyzed syntactically, some work on that-trace supports a syntax-prosody account (Kandybowicz, 2006). The Interface Hypothesis predicts that bilinguals will have difficulty with interface phenomena but not narrow syntax, such that testing bilinguals’ knowledge of that-trace provides a unique testing ground for comparing the two approaches. We demonstrate that bilinguals have the syntactic underpinnings necessary for both syntactic and syntax-prosody accounts of that-trace; however, they differ from the monolinguals with regard to that-trace, extending the phenomenon’s restriction on extraction to a new context, supporting a syntax-prosody account of that-trace. Book description: Contemporary Trends in Hispanic and Lusophone Linguistics offers a panorama of current research into multiple varieties of Spanish from several different regions (Mexico, Puerto Rico, Spain, Costa Rica, Argentina, Bolivia, Peru, Honduras), Catalan, Brazilian Portuguese, as well as varieties in contact with English and Purépecha. The first part of the volume focuses on the structural aspects and use of these languages in the areas of syntax, semantics, sociolinguistics, diachrony, phonetics, phonology and morphology. The second part discusses the effect of interacting multiple grammars, namely, first language acquisition, second language acquisition, varieties in contact, and bilingualism. As a whole, the contributions in this volume provide a methodological balance between qualitative and quantitative approaches to Language and, in this way, represent contemporary trends in Hispanic and Lusophone linguistics

Why Is There No Raising to Object in Spanish? A Study of Code-Switching

Raising to Object (RtoObj), like other types of Raising configurations, features a determiner phrase (DP) in a dual-clausal relationship with both the matrix and the embedded clauses. RtoO is possible in English and a few other languages, most famously, Icelandic. However, it is not possible in many other languages, such as Spanish. As far as we can tell, insight into what licenses RtoObj is largely speculative. The main goal of this paper is to limit the range of possible hypotheses by pinpointing the source of the cross-linguistic difference using code-switching data. A priori, we could hypothesize two possible sources for the licensor of RtoObj: it could be a feature in the matrix clause or a feature in the infinitival complement. In this chapter, we present code-switching data that support the second option: English TdefP is linked to the licensing of RtoObj. We find that early Spanish/English bilinguals overwhelmingly prefer code-switched RtoObj samples when the infinitival complement is in English and they reject RtoObj when the complement is a Spanish infinitival. This suggests that Spanish Tdef is either different or altogether missing