Veegerelateerde MRSA: epidemiologie in dierlijke productieketens, transmissie naar de mens en karakterisatie van de kloon

Onderzoek waarin gepoogd werd om meer inzicht te krijgen in het voorkomen van MRSA in de Nederlandse veehouderij. De varkenshouderij, vleeskalverhouderij en pluimveehouderij werden onderzocht. Geconcludeerd wordt dat MRSA wijdverspreid voorkomt in de intensieve veehouderij en dat Nederland hierin niet uniek is. In het bijzonder het type ST398 vormt een probleem, omdat het zich goed kan verspreiden en aanpasse

The effect of floating houses on water quality

The need of an adaptive sustainable solution for the increased land scarcity, growing urbanization, climate change and flood risks resulted in the concept of the floating urbanization. In The Netherlands this new type of housing attracted the interest of local authorities, municipalities and water boards. Moreover, plans to incorporate floating houses in the urban planning have already been developed. However, the knowledge gap regarding the potential effect on the water quality halts the further development of the floating houses. This paper shows the results of a water quality measurement campaign, as part of the national program “Knowledge for climate”, at a small floating houses project in Delft and serves as a case study for addressing the environmental-ecological knowledge gap on this topic

Tailoring the Implementation of New Biomarkers Based on Their Added Predictive Value in Subgroups of Individuals

Background\ud The value of new biomarkers or imaging tests, when added to a prediction model, is currently evaluated using reclassification measures, such as the net reclassification improvement (NRI). However, these measures only provide an estimate of improved reclassification at population level. We present a straightforward approach to characterize subgroups of reclassified individuals in order to tailor implementation of a new prediction model to individuals expected to benefit from it.\ud \ud Methods\ud In a large Dutch population cohort (n = 21,992) we classified individuals to low (<5%) and high (≥5%) fatal cardiovascular disease risk by the Framingham risk score (FRS) and reclassified them based on the systematic coronary risk evaluation (SCORE). Subsequently, we characterized the reclassified individuals and, in case of heterogeneity, applied cluster analysis to identify and characterize subgroups. These characterizations were used to select individuals expected to benefit from implementation of SCORE.\ud \ud Results\ud Reclassification after applying SCORE in all individuals resulted in an NRI of 5.00% (95% CI [-0.53%; 11.50%]) within the events, 0.06% (95% CI [-0.08%; 0.22%]) within the nonevents, and a total NRI of 0.051 (95% CI [-0.004; 0.116]). Among the correctly downward reclassified individuals cluster analysis identified three subgroups. Using the characterizations of the typically correctly reclassified individuals, implementing SCORE only in individuals expected to benefit (n = 2,707,12.3%) improved the NRI to 5.32% (95% CI [-0.13%; 12.06%]) within the events, 0.24% (95% CI [0.10%; 0.36%]) within the nonevents, and a total NRI of 0.055 (95% CI [0.001; 0.123]). Overall, the risk levels for individuals reclassified by tailored implementation of SCORE were more accurate.\ud \ud Discussion\ud In our empirical example the presented approach successfully characterized subgroups of reclassified individuals that could be used to improve reclassification and reduce implementation burden. In particular when newly added biomarkers or imaging tests are costly or burdensome such a tailored implementation strategy may save resources and improve (cost-)effectivenes

The patients' experience of neuroimaging of primary brain tumors: a cross-sectional survey study

PURPOSE: To gain insight into how patients with primary brain tumors experience MRI, follow-up protocols, and gadolinium-based contrast agent (GBCA) use. METHODS: Primary brain tumor patients answered a survey after their MRI exam. Questions were analyzed to determine trends in patients' experience regarding the scan itself, follow-up frequency, and the use of GBCAs. Subgroup analysis was performed on sex, lesion grade, age, and the number of scans. Subgroup comparison was made using the Pearson chi-square test and the Mann-Whitney U-test for categorical and ordinal questions, respectively. RESULTS: Of the 100 patients, 93 had a histopathologically confirmed diagnosis, and seven were considered to have a slow-growing low-grade tumor after multidisciplinary assessment and follow-up. 61/100 patients were male, with a mean age ± standard deviation of 44 ± 14 years and 46 ± 13 years for the females. Fifty-nine patients had low-grade tumors. Patients consistently underestimated the number of their previous scans. 92% of primary brain tumor patients did not experience the MRI as bothering and 78% would not change the number of follow-up MRIs. 63% of the patients would prefer GBCA-free MRI scans if diagnostically equally accurate. Women found the MRI and receiving intravenous cannulas significantly more uncomfortable than men (p = 0.003). Age, diagnosis, and the number of previous scans had no relevant impact on the patient experience. CONCLUSION: Patients with primary brain tumors experienced current neuro-oncological MRI practice as positive. Especially women would, however, prefer GBCA-free imaging if diagnostically equally accurate. Patient knowledge of GBCAs was limited, indicating improvable patient information