Inspectors' responses to adolescents' assessment of quality of care: A case study on involving adolescents in inspections

Background: Users of care services are increasingly participating in inspections of the quality of care. In practice, incorporating service users' views is difficult, as users may have other views on good care than inspectors and thus give information that does not fit the inspectors' assessment criteria. This study compared the views on good care of young care users (adolescents) and inspectors, seeking to understand what the differences and similarities mean to incorporating the users' views in inspections. Methods: We conducted a single-case study combining document analysis with a meeting with inspectors. The selected case came from a Dutch inspectorate and involved a thematic inspection of care for children growing up poor. Results: Inspectors and adolescents agree on the importance of timely care, creating opportunities for personal development, and a respectful relationship. The views on quality of care differ with regard to sharing information, creating solutions, and the right moment to offer help. We identified three ways inspectors deal with the differences: 1) prioritize their own views, 2) pass the problem onto others to solve, and 3) separate the differing perspectives. With similar viewpoints, inspectors use the adolescents' views to support their assessments. When viewpoints conflict, information from adolescents does not affect the inspectors' judgments. Explanations are related to the vulnerability of the adolescents involved, the inspectorate's organizational rules and routines and the external regulatory context. Conclusions: Service user involvement in inspections potentially impacts the quality of care. Yet, conflicts between the views of service users and inspectors are not easily overcome in the regulatory context

Retrospective Serology Study of Respiratory Virus Infections in Captive Great Apes

Great apes are extremely sensitive to infections with human respiratory viruses. In this study, we retrospectively analyzed sera from captive chimpanzees, gorillas and orang-utans. More than 1000 sera (403 chimpanzee, 77 gorilla, and 535 orang-utan sera) were analyzed for antibodies to the human respiratory viruses RSV (respiratory syncytial virus, hMPV (human metapneumovirus), H1N1 and H3N2 influenza A viruses, and influenza B virus. In all ape species high seroprevalences were found for RSV, hMPV, and influenza B virus. A high percentage of captive chimpanzees also showed evidence of influenza A H1N1 infections, and had low levels of H3N2 antibodies, while in sera from gorillas and orang-utans antibody levels to influenza A and B viruses were much lower or practically absent. Transmission of respiratory viruses was examined in longitudinal sera of young chimpanzees, and in chimpanzee sera taken during health checks. In young animals isolated cases of influenza infections were monitored, but evidence was found for single introductions followed by a rapid dissemination of RSV and hMPV within the group. Implementation of strict guidelines for handling and housing of nonhuman primates was shown to be an efficient method to reduce the introduction of respiratory infections in colonies of captive animals. RSV seroprevalence rates of chimpanzees remained high, probably due to circulating virus in the chimpanzee colony

Characterization of NK subsets during WNV infection.

<p>(A) Representative example of the gating strategy. CD3−, CD45+, CD14− cells were selected from the lymphogate. Depending on the expression of CD56 and CD16 NK-cells were divided into three subsets. (B) Full circles represent the total NK population and from each individual animal the fraction of CD56^bright, CD16^bright and D16^negCD56^neg of total NK population is shown at 4 time points after WNV infection. (C) Percentage of CD16^bright NK-cells of total lymphocyte population. (D) CD161 expression on CD16^bright NK-cells. (E) NKG2A expression on CD16^bright NK-cells. (F) NKp44 expression on CD16^bright NK-cells.</p

Time schedule.

<p>On each time line, blue arrows indicate the time-points of the implantation of the data loggers for temperature registration, the intradermal WNV infection, and euthanasia. Red arrows indicate the bleeding time-points in the follow-up period. The numbers on the time line represent the days post-infection. Names of the animals are depicted with the “R”-animals being rhesus macaques and the “M”-animals being common marmosets.</p

Humoral response after WNV infection.

<p>WNV-E-protein-specific IgM and IgG levels of the individual animals during WNV infection. The antibody binding was calculated as the absorbance at 450 nm minus the absorbance at 520 nm. The mean value of two independent measurements of 1∶50 diluted samples is depicted in the figure.</p

West Nile virus tissue distribution in infected rhesus macaques and common marmosets.

1<p>For abbreviations see <a href="http://www.plosntds.org/article/info:doi/10.1371/journal.pntd.0002797#s2" target="_blank">methods</a> section.</p

Development of Refractive Errors—What Can We Learn From Inherited Retinal Dystrophies?

Purpose It is unknown which retinal cells are involved in the retina-to-sclera signaling cascade causing myopia. As inherited retinal dystrophies (IRD) are characterized by dysfunction of a single retinal cell type and have a high risk of refractive errors, a study investigating the affected cell type, causal gene, and refractive error in IRDs may provide insight herein. Design Case-control study. Methods STUDY POPULATION: Total of 302 patients with IRD from 2 ophthalmogenetic centers in the Netherlands. REFERENCE POPULATION: Population-based Rotterdam Study-III and Erasmus Rucphen Family Study (N = 5550). Distributions and mean spherical equivalent (SE) were calculated for main affected cell type and causal gene; and risks of myopia and hyperopia were evaluated using logistic regression. Results Bipolar cell-related dystrophies were associated with the highest risk of SE high myopia 239.7; odds ratio (OR) mild hyperopia 263.2, both P <.0001; SE −6.86 diopters (D) (standard deviation [SD] 6.38), followed by cone-dominated dystrophies (OR high myopia 19.5, P <.0001; OR high hyperopia 10.7, P =.033; SE −3.10 D [SD 4.49]); rod dominated dystrophies (OR high myopia 10.1, P <.0001; OR high hyperopia 9.7, P =.001; SE −2.27 D [SD 4.65]), and retinal pigment epithelium (RPE)-related dystrophies (OR low myopia 2.7; P =.001; OR high hyperopia 5.8; P =.025; SE −0.10 D [SD 3.09]). Mutations in RPGR (SE −7.63 D [SD 3.31]) and CACNA1F (SE −5.33 D [SD 3.10]) coincided with the highest degree of myopia and in CABP4 (SE 4.81 D [SD 0.35]) with the highest degree of hyperopia. Conclusions Refractive errors, in particular myopia, are common in IRD. The bipolar synapse and the inner and outer segments of the photoreceptor may serve as critical sites for myopia development