Effect on diagnostic yield of repeated stool testing during outbreaks of Clostridium difficile-associated disease

ABSTRACTThe effect on diagnostic yield of testing sequential stools was assessed during two hospital epidemics of Clostridium difficile. Using a rapid immunoassay, C. difficile-associated disease was diagnosed in 237 diarrhoeal patients, of whom 204 (86%) were diagnosed from the first faeces sample and 12 (5%) were diagnosed from follow-up samples obtained within 1 week. The remaining 21 (9%) patients yielded a positive test from stools obtained >1 week after the initial negative sample. It was concluded that repeated testing of stools for C. difficile toxin is of value in controlling outbreaks of C. difficile infection

Branching of the Falkner-Skan solutions for λ < 0

The Falkner-Skan equation f'" + ff" + λ(1 - f'^2) = 0, f(0) = f'(0) = 0, is discussed for λ < 0. Two types of problems, one with f'(∞) = 1 and another with f'(∞) = -1, are considered. For λ = 0- a close relation between these two types is found. For λ < -1 both types of problem allow multiple solutions which may be distinguished by an integer N denoting the number of zeros of f' - 1. The numerical results indicate that the solution branches with f'(∞) = 1 and those with f'(∞) = -1 tend towards a common limit curve as N increases indefinitely. Finally a periodic solution, existing for λ < -1, is presented.

Profiling the Dead: Generating Microsatellite Data from Fossil Bones of Extinct Megafauna—Protocols, Problems, and Prospects

We present the first set of microsatellite markers developed exclusively for an extinct taxon. Microsatellite data have been analysed in thousands of genetic studies on extant species but the technology can be problematic when applied to low copy number (LCN) DNA. It is therefore rarely used on substrates more than a few decades old. Now, with the primers and protocols presented here, microsatellite markers are available to study the extinct New Zealand moa (Aves: Dinornithiformes) and, as with single nucleotide polymorphism (SNP) technology, the markers represent a means bywhich the field of ancient DNA can (preservation allowing) move on from its reliance on mitochondrial DNA. Candidate markers were identified using high throughput sequencing technology (GS-FLX) on DNA extracted from fossil moa bone and eggshell. From the ‘shotgun’ reads, .60 primer pairs were designed and tested on DNA from bones of the South Island giant moa (Dinornis robustus). Six polymorphic loci were characterised and used to assess measures of genetic diversity. Because of low template numbers, typical of ancient DNA, allelic dropout was observed in 36–70% of the PCR reactions at each microsatellite marker. However, a comprehensive survey of allelic dropout, combined with supporting quantitative PCR data, allowed us to establish a set of criteria that maximised data fidelity. Finally, we demonstrated the viability of the primers and the protocols, by compiling a full Dinornis microsatellite dataset representing fossils of c. 600–5000 years of age. A multi-locus genotype was obtained from 74 individuals (84% success rate), and the data showed no signs of being compromised by allelic dropout. The methodology presented here provides a framework by which to generate and evaluate microsatellite data from samples of much greater antiquity than attempted before, and opens new opportunities for ancient DNA research

Lower Extremity Amputation Rates in People With Diabetes Mellitus:A Retrospective Population Based Cohort Study in Zwolle Region, The Netherlands

OBJECTIVE: Lower extremity amputations are a major complication of diabetes mellitus (DM). In a previous Dutch study, the incident rate of major amputations was 89.2 per 100 000 person years. The primary aim of this study was to describe the lower extremity amputation rates in people with DM in the Zwolle region, where preventive and curative footcare is organised according to the guidelines of the International Working Group of the Diabetic Foot (IWGDF). The secondary aim was to evaluate outcomes and underlying characteristics of these people.METHODS: This was a retrospective regional population based cohort study. Data from all people with DM treated in primary and secondary care, living in the region Zwolle were collected. All amputations in the period 2017 to 2019 were analysed. Comparisons were made between those with and without an amputation.RESULTS: In the analysis 5 915 people with DM were included, with a mean age of 67.8 (IQR 57.9, 75.9) years. Of those people, 47% were women and the median HbA1c was 53 (IQR 47, 62) mmol/mol. Over the three year study period, a total of 68 amputations were performed in 59 people: 46 minor, 22 major. This translated into an average annual crude amputation incidence rate of non-traumatic major and minor amputations of 41.5 and 86.9 per 100 000 person years among people with diabetes. Compared with those not undergoing amputations, those who underwent an amputation were more often men, older, mainly had T2DM, were treated in secondary care, had higher diastolic blood pressure, worse diabetic footcare profile, longer DM duration and higher HbA1c. At the end of the follow up, 111 people died: 96 (1.6%) without and 15 (25.4%) with amputations (p &lt; .001).CONCLUSIONS: This retrospective study provides detailed insight into the rate of amputations in Dutch people with diabetes in the region Zwolle. Compared with previous Dutch estimates, these data suggest a considerable decrease in major amputation incidence rate.</p

De plattelandseconomie in Nederland; Een verkenning van definities, indicatoren, instituties en beleid

In deze studie wordt een beeld geschetst van de plattelandseconomie in Nederland en wordt onderzocht hoe de plattelandseconomie kan worden versterkt. Er wordt met twee verschillende ruimtelijke afbakeningen van de plattelandseconomie gewerkt: COROPgebieden en het landelijk gebied buiten de dorpen en steden. Het behoud van de duurzame kwaliteit van het landschap blijkt een belangrijk zorgpunt in de Nederlandse plattelandseconomie te zijn. Uit een voorlopige toetsing van een aantal beleidsinstrumenten, waarbij uitdrukkelijk aandacht wordt besteed aan institutionele aspecten, komt naar voren dat het Programma Beheer, Beheer door Staatsbosbeheer en Grondverwerving veelbelovende instrumenten lijken te zijn ter ondersteuning van de kwaliteit van het landschap. In this study, an overview of the Dutch rural economy is given and it is explored by which means the Dutch rural economy can be strengthened. Two different spatial approaches of the rural economy are used: the first at NUTS 3 level, whereas the second one focuses on rural areas outside towns and villages. The maintenance of a sustainable quality of landscape appears to be a main concern of the Dutch rural economy. A provisional analysis of policy instruments with specific attention to institutional aspects reveals that the so-called 'Programma Beheer', 'Beheer door Staatsbosbeheer' and 'Grondverwerving' (instruments all directed at landscape management by farmers or nature organisations) are amongst the promising instruments for supporting landscape quality

Glucocorticoid-Induced Attenuation of the Inflammatory Response in Zebrafish.

Glucocorticoids are steroid hormones that are secreted upon stress. Their effects are mediated by the glucocorticoid receptor, which acts as a transcription factor. Because the antiinflammatory activity of glucocorticoids has been well established, they are widely used clinically to treat many inflammatory and immune-related diseases. However, the exact specificity, mechanisms, and level of regulation of different inflammatory pathways have not been fully elucidated. In the present study, a tail fin amputation assay was used in 3-day-old zebrafish larvae to study the immunomodulatory effects of the synthetic glucocorticoid beclomethasone. First, a transcriptome analysis was performed, which showed that upon amputation mainly immune-related genes are regulated. This regulation was inhibited by beclomethasone for 86% of regulated genes. For two immune-related genes, tlr4bb and alox5ap, the amputation-induced increase was not attenuated by beclomethasone. Alox5ap is involved in eicosanoid biosynthesis, but the increase in leukotriene B4 concentration upon amputation was abolished, and lipoxin A4 levels were unaffected by beclomethasone. Furthermore, we studied the migration of neutrophils and macrophages toward the wound site. Our results show that amputation induced migration of both types of leukocytes and that this migration was dependent on de novo protein synthesis. Beclomethasone treatment attenuated the migratory behavior of neutrophils in a glucocorticoid receptor-dependent manner but left the migration of macrophages unaffected. In conclusion, beclomethasone has a dramatic inhibitory effect on the amputation-induced proinflammatory gene regulation, and this is reflected in an inhibition of the neutrophil migration but not the migration of macrophages, which are likely to be involved in inflammation resolution.Animal science

Sex differences in cardiometabolic risk factors, pharmacological treatment and risk factor control in type 2 diabetes:findings from the Dutch Diabetes Pearl cohort

Introduction Sex differences in cardiometabolic risk factors and their management in type 2 diabetes (T2D) have not been fully identified. Therefore, we aimed to examine differences in cardiometabolic risk factor levels, pharmacological treatment and achievement of risk factor control between women and men with T2D. Research design and methods Cross-sectional data from the Dutch Diabetes Pearl cohort were used (n=6637, 40% women). Linear and Poisson regression analyses were used to examine sex differences in cardiometabolic risk factor levels, treatment, and control. Results Compared with men, women had a significantly higher body mass index (BMI) (mean difference 1.79 kg/m 2 (95% CI 1.49 to 2.08)), while no differences were found in hemoglobin A 1c (HbA 1c) and systolic blood pressure (SBP). Women had lower diastolic blood pressure (-1.94 mm Hg (95% CI -2.44 to -1.43)), higher total cholesterol (TC) (0.44 mmol/L (95% CI 0.38 to 0.51)), low-density lipoprotein cholesterol (LDL-c) (0.26 mmol/L (95% CI 0.22 to 0.31)), and high-density lipoprotein cholesterol (HDL-c) sex-standardized (0.02 mmol/L (95% CI 0.00 to 0.04)), and lower TC:HDL ratio (-0.29 (95% CI -0.36 to -0.23)) and triglycerides (geometric mean ratio 0.91 (95% CI 0.85 to 0.98)). Women had a 16% higher probability of being treated with antihypertensive medication in the presence of high cardiovascular disease (CVD) risk and elevated SBP than men (relative risk 0.84 (95% CI 0.73 to 0.98)), whereas no sex differences were found for glucose-lowering medication and lipid-modifying medication. Among those treated, women were less likely to achieve treatment targets of HbA 1c (0.92 (95% CI 0.87 to 0.98)) and LDL-c (0.89 (95% CI 0.85 to 0.92)) than men, while no differences for SBP were found. Conclusions In this Dutch T2D population, women had a slightly different cardiometabolic risk profile compared with men and a substantially higher BMI. Women had a higher probability of being treated with antihypertensive medication in the presence of high CVD risk and elevated SBP than men, and were less likely than men to achieve treatment targets for HbA 1c and LDL levels

Whose right to the city? An analysis of the mediatized politics of place surrounding alojamento local issues in Lisbon and Porto

In view of the proliferation of alojamento local (short-term vacation rentals) in the major Portuguese cities of Lisbon and Porto, along with the recent transformation of the historic city centre neighbourhoods, this study explores the mediatized politics of place by analysing data sets resulting from different, but interconnected, discursive practices. At the level of governance, we examine how legislation has enabled and facilitated this transformation. We then explore the media coverage of the issues surrounding these recent changes. Finally, we focus on individual and collective stakeholder voices by analysing the various rights claims and arguments found in social media communication channels. Framing our analysis initially in Lefebvre’s concept of ‘the right to the city’, often invoked as an argument for the promotion of justice, inclusion and sustainability in the face of urbanisation policies, we argue that a ‘rights in the city’ approach is better suited to gaining insight into the multiple tensions and conflicts brought about through the interlinking processes of regeneration, gentrification and touristification that affect neighbourhoods with high proportions of short-term rental accommodation, and conclude that there are many rights claimants within a seemingly unified group of stakeholders, invoking rights claims which are sometimes overlapping, but often conflicting.info:eu-repo/semantics/publishedVersio