Dutch patients, retail chicken meat and poultry share the same ESBL genes, plasmids and strains

Intestinal carriage of extended-spectrum beta-lactamase (ESBL) -producing bacteria in food-producing animals and contamination of retail meat may contribute to increased incidences of infections with ESBL-producing bacteria in humans. Therefore, distribution of ESBL genes, plasmids and strain genotypes in Escherichia coli obtained from poultry and retail chicken meat in the Netherlands was determined and defined as ‘poultry-associated’ (PA). Subsequently, the proportion of E. coli isolates with PA ESBL genes, plasmids and strains was quantified in a representative sample of clinical isolates. The E. coli were derived from 98 retail chicken meat samples, a prevalence survey among poultry, and 516 human clinical samples from 31 laboratories collected during a 3-month period in 2009. Isolates were analysed using an ESBL-specific microarray, sequencing of ESBL genes, PCR-based replicon typing of plasmids, plasmid multi-locus sequence typing (pMLST) and strain genotyping (MLST). Six ESBL genes were defined as PA (blaCTX-M-1, blaCTX-M-2, blaSHV-2, blaSHV-12, blaTEM-20, blaTEM-52): 35% of the human isolates contained PA ESBL genes and 19% contained PA ESBL genes located on IncI1 plasmids that were genetically indistinguishable from those obtained from poultry (meat). Of these ESBL genes, 86% were blaCTX-M-1 and blaTEM-52 genes, which were also the predominant genes in poultry (78%) and retail chicken meat (75%). Of the retail meat samples, 94% contained ESBL-producing isolates of which 39% belonged to E. coli genotypes also present in human samples. These findings are suggestive for transmission of ESBL genes, plasmids and E. coli isolates from poultry to humans, most likely through the food chain

Treatment-limiting decisions in patients with severe traumatic brain injury in the Netherlands

Introduction: Treatment-limiting decisions (TLDs) can be inevitable severe traumatic brain injury (s-TBI) patients, but data on their use remain scarce. Research question: To investigate the prevalence, timing and considerations of TLDs in s-TBI patients. Material and methods: s-TBI patients between 2008 and 2017 were analysed retrospecively. Patient data, timing, location, involvement of proxies, and reasons for TLDs were collected. Baseline characteristics and in-hospital outcomes were compared between s-TBI patients with and without TLDs. Results: TLDs were reported in 117 of 270 s-TBI patients (43.3%) and 95.9% of deaths after s-TBI were preceded by a TLD. The majority of TLDs (68.4%) were categorized as withdrawal of therapy, of which withdrawal of organ-support in 64.1%. Neurosurgical intervention was withheld in 29.9%. The median time from admission to TLD was 2 days [IQR, 0–8] and 50.4% of TLDs were made within 3 days of admission. The main reason for a TLD was that the patients were perceived as unsalvageable (66.7%). Nearly all decisions were made multidisciplinary (99.1%) with proxies involvement (75.2%). The predicted mortality (CRASH-score) between patients with and without TLDs were 72.6 vs. 70.6%. The percentage of TLDs in s-TBI patients increased from 20.0% in 2008 to 42.9% in 2012 and 64.3% in 2017. Discussion and conclusion: TLDs occurred in almost half of s-TBI patients and were instituted more frequently over time. Half of TLDs were made within 3 days of admission in spite of baseline prognosis between groups being similar. Future research should address whether prognostic nihilism contributes to self-fulfilling prophecies.</p

A Laboratory Study of the Effects of Size, Density, and Shape on the Wave‐Induced Transport of Floating Marine Litter

Floating marine litter is transported by several mechanisms, including surface waves. In studies of marine litter transport, the wave‐induced drift is set to be equal to the Stokes drift, corresponding to the Lagrangian‐mean wave‐induced drift of an infinitesimally small tracer. Large‐scale experiments are used to show how the wave‐induced drift of objects of finite size depends on their size, density, and shape. We observe increases in drift of 95% compared to Stokes drift for discs with diameters of 13% of the wavelength, up to 23% for spheres with diameters of 3% of the wavelength, whereas drift is reduced for objects that become submerged such as nets. We investigate what these findings may imply for the transport of plastic pollution in realistic wave conditions and we predict an increase in wave‐induced drift for (very) large plastic pollution objects. The different extrapolation techniques we explore to make this prediction exhibit a large range of uncertainty

Fean wetter buorkje II : Samenvattende rapportage praktijkproeven hoger zomerpeil Fries Veenweidegebied 2007-2008

De provincie Fryslân en Wetterskip Fryslân zoeken naar een vorm van peilbeheer die de bodemdaling in het Friese veenweidegebied vertraagt, maar een sterke landbouw niet in de weg staat. De oplossing wordt gezocht in hoger zomerpeil. Daarbij is ’s zomers, wanneer vanwege de lagere grondwaterstanden en de hogere temperaturen 90% van de bodemdaling plaatsvindt, de drooglegging 60-70 cm, terwijl die ‘s winters 90 cm blijft

Persistent high burden and mortality associated with advanced HIV disease in rural Tanzania despite uptake of World Health Organization "test and treat" guidelines

BACKGROUND: Information about burden, characteristics, predictors, and outcomes of advanced human immunodeficiency virus disease (AHD) is scarce in rural settings of sub-Saharan Africa. Human immunodeficiency virus (HIV) infections and associated deaths remain high despite specific guidelines issued by the World Health Organization (WHO). METHODS: Burden of AHD and 6-month death/loss to follow-up (LTFU) were described among 2498 antiretroviral therapy (ART)-naive nonpregnant people with HIV (PWH) aged >15 years enrolled in the Kilombero Ulanga Antiretroviral Cohort in rural Tanzania between 2013 and 2019. Baseline characteristics associated with AHD and predictors of death/LTFU among those with AHD were analyzed using multivariate logistic and Cox regression, respectively. RESULTS: Of the PWH, 62.2% had AHD at diagnosis (66.8% before vs 55.7% after national uptake of WHO "test and treat" guidelines in 2016). At baseline, older age, male sex, lower body mass index, elevated aminotransferase aspartate levels, severe anemia, tachycardia, decreased glomerular filtration rate, clinical complaints, impaired functional status, and enrollment into care before 2018 were independently associated with AHD. Among people with AHD, incidence of mortality, and LTFU were 16 and 34 per 100 person-years, respectively. WHO clinical stage 3 or 4, CD4 counts <100 cells/microL, severe anemia, tachypnea, and liver disease were associated with death/LTFU. CONCLUSIONS: More than 50% of PWH enrolled in our cohort after test and treat implementation still had AHD at diagnosis. Increasing HIV testing and uptake and implementation of the WHO-specific guidelines on AHD for prevention, diagnosis, treatment of opportunistic infections, and reducing the risks of LTFU are urgently needed to reduce morbidity and mortality

Generalized Robba rings

We prove that any projective coadmissible module over the locally analytic distribution algebra of a compact $p$-adic Lie group is finitely generated. In particular, the category of coadmissible modules does not have enough projectives. In the Appendix a "generalized Robba ring" for uniform pro-$p$ groups is constructed which naturally contains the locally analytic distribution algebra as a subring. The construction uses the theory of generalized microlocalization of quasi-abelian normed algebras that is also developed there. We equip this generalized Robba ring with a self-dual locally convex topology extending the topology on the distribution algebra. This is used to show some results on coadmissible modules.Comment: with an appendix by Peter Schneider; revised; new titl

Threat of an influenza pandemic: family physicians in the front line

<p>Abstract</p> <p>Background</p> <p>The chance of an influenza pandemic is real and clinicians should keep themselves informed about the rationale and science behind preventive and therapeutic principles relating to an (impending) influenza pandemic.</p> <p>Discussion</p> <p>Vaccination is considered the best prevention in case of a pandemic threat and first choice to contain the impact of a pandemic. Pending the availability of an effective pandemic vaccine, antivirals are likely the only effective agents for prevention and treatment. When an influenza pandemic is impending, all interventions aim to prevent people becoming infected and to suppress replication and transmission of the virus as much as possible. Antivirals will be prescribed to patients with laboratory confirmed pre-pandemic influenza as well as to their contacts (post-exposure prophylaxis) which may delay development of or even prevent a pandemic. During a manifest influenza pandemic, however, there is large-scale spreading of the influenza virus. Therefore, preventive use of antivirals is less efficient to prevent transmission. Delaying the pandemic is then important in order to prevent exhausting public health resources and disruption of society. Thus, during a manifest pandemic everyone with influenza symptoms should receive antivirals as quickly as possible, regardless of virological confirmation. To ensure optimal effectiveness of antivirals and to minimize development of drug resistant viral strains, the use of antivirals for annual influenza should be restrictive. The crucial position of family physicians during an (impending) influenza pandemic necessitates the development of primary health care guidelines on this topic for all countries.</p> <p>Summary</p> <p>Family physicians will play a key role in assessing and treating victims of a new influenza virus, and in reassuring the worried well. We outline various possible interventions in the event of an impending and a manifest influenza pandemic, such as non-medial measures, prescription of antivirals, and vaccination, and emphasize the need for pandemic influenza preparedness.</p

Anti-Malaria Drug Mefloquine Induces Motor Learning Deficits in Humans

Mefloquine (a marketed anti-malaria drug) prophylaxis has a high risk of causing adverse events. Interestingly, animal studies have shown that mefloquine imposes a major deficit in motor learning skills by affecting the connexin 36 gap junctions of the inferior olive. We were therefore interested in assessing whether mefloquine might induce similar effects in humans. The main aim of this study was to investigate the effect of mefloquine on olivary-related motor performance and motor learning tasks in humans. We subjected nine participants to voluntary motor timing (dart throwing task), perceptual timing (rhythm perceptual task) and reflex timing tasks (eye-blink task) before and 24 h after the intake of mefloquine. The influence of mefloquine on motor learning was assessed by subjecting participants with and without mefloquine intake (controls: n = 11 vs mefloquine: n = 8) to an eye-blink conditioning task. Voluntary motor performance, perceptual timing, and reflex blinking were not affected by mefloquine use. However, the influence of mefloquine on motor learning was substantial; both learning speed as well as learning capacity was impaired by mefloquine use. Our data suggest that mefloquine disturbs motor learning skills. This adverse effect can have clinical as well as social clinical implications for mefloquine users. Therefore, this side-effect of mefloquine should be further investigated and recognized by clinicians

Genetic evolution of uveal melanoma guides the development of an inflammatory microenvironment

Experimental cancer immunology and therap

Process waste treatment system upgrades: Clarifier startup at the nonradiological wastewater treatment plant

The Waste Management Operations Division at Oak Ridge National Laboratory recently modified the design of a reactor/clarifier at the Nonradiological Wastewater Treatment Plant, which is now referred to as the Process Waste Treatment Complex--Building 3608, to replace the sludge-blanket softener/clarifier at the Process Waste Treatment Plant, now referred to as the Process Waste Treatment Complex-Building 3544 (PWTC-3544). This work was conducted because periodic hydraulic overloads caused poor water-softening performance in the PWTC-3544 softener, which was detrimental to the performance and operating costs of downstream ion-exchange operations. Over a 2-month time frame, the modified reactor/clarifier was tested with nonradiological wastewater and then with radioactive wastewater to optimize softening performance. Based on performance to date, the new system has operated more effectively than the former one, with reduced employee radiological exposure, less downtime, lower costs, and improved effluent quality