Longitudinal Study of Extended-Spectrum-β-Lactamase- and AmpC-Producing Enterobacteriaceae in Household Dogs

A longitudinal study was performed to (i) investigate the continuity of shedding of extended-spectrum-beta-lactamase (ESBL)-producing Enterobacteriaceae in dogs without clinical signs, (ii) identify dominant plasmid-mediated ESBL genes, and (iii) quantify ESBL-producing Enterobacteriaceae in feces. Fecal samples from 38 dogs were collected monthly for 6 months. Additional samples were collected from 7 included dogs on a weekly basis for 6 weeks. Numbers of CFU per gram of feces for non-wild-type Enterobacteriaceae were determined by using MacConkey agar supplemented with 1 mg/liter cefotaxime (MCC), and those for total Enterobacteriaceae were determined by using MacConkey agar. Cefotaxime-resistant isolates were screened by PCR and sequence analysis for the presence of bla_CTX-M, bla_CMY, bla_SHV, bla_OXA, and bla_TEM gene families. Bacterial species were identified by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS) analysis. PCR-negative isolates were tested by a double-disk synergy test for enhanced AmpC expression. A total of 259 samples were screened, and 126 samples were culture positive on MCC, resulting in 352 isolates, 327 of which were Escherichia coli. Nine dogs were continuously positive during this study, and 6 dogs were continuously negative. Monthly or weekly shifts in fecal shedding were observed for 23 dogs. Genotyping showed a large variety of ESBL genes and gene combinations at single and multiple consecutive sampling moments. The ESBL genes bla_CTX-M-1, bla_CTX-M-14, bla_CTX-M-15, bla_SHV-12, and bla_CMY-2 were most frequently found. The mean number of CFU of non-wild-type Enterobacteriaceae was 6.11 × 10⁸ CFU/g feces. This study showed an abundance of ESBL-producing Enterobacteriaceae in dogs in the Netherlands, mostly in high concentrations. Fecal shedding was shown to be highly dynamic over time, which is important to consider when studying ESBL epidemiology.     

Processing consequences of superfluous and missing prosodic breaks in auditory sentence comprehension

This ERP study investigates whether a superfluous prosodic break (i.e., a prosodic break that does not coincide with a syntactic break) has more severe processing consequences during auditory sentence comprehension than a missing prosodic break (i.e., the absence of a prosodic break at the position of a syntactic break). Participants listened to temporarily ambiguous sentences involving a prosody–syntax match or mismatch. The disambiguation of these sentences was always lexical in nature in the present experiment. This contrasts with a related study by Pauker, Itzhak, Baum, and Steinhauer (2011), where the disambiguation was of a lexical type for missing PBs and of a prosodic type for superfluous PBs. Our results converge with those of Pauker et al. (2011): superfluous prosodic breaks lead to more severe processing problems than missing prosodic breaks. Importantly, the present results extend those of Pauker et al. (2011) showing that this holds when the disambiguation is always lexical in nature. Furthermore, our results show that the way listeners use prosody can change over the course of the experiment which bears consequences for future studies.     

Acceptance and long-term compliance of nCPAP in obstructive sleep apnea

In a retrospective cohort study, we evaluated whether improvements in nasal continuous positive airway pressure (nCPAP) technology, particularly the introduction of automatic adjustment of the nCPAP pressure (auto-CPAP), have led to better acceptance and (long-term) compliance in patients with obstructive sleep apnea syndrome (OSAS) as compared to earlier reported data. Questionnaires were sent to 256 patients, who were referred to our clinic for an overnight polysomnography from January 1997 to July 2005 and received nCPAP therapy for OSAS. Of the 256 patients, 24 patients were unavailable for follow-up. Of the remaining 232 patients, 58 patients (25%) had discontinued therapy, while 174 patients (75%) were still using nCPAP after 2 months to 8 years of follow-up. One Hundred and thirty eight (79%) of these 174 patients used nCPAP for at least 4 h/night during ≥ 5 nights/week, 82,1% of the conventional nCPAP (fixed pressure CPAP) group (n = 78) and 77,1% of the auto-CPAP group (n = 96). Therefore, including the 58 failures, only 59.5% of patients can be seen as compliant. There were no statistical differences between the fixed pressure CPAP and auto-CPAP users, and between the compliant and non-compliant users according to age, BMI, AHI and Epworth sleepiness scale (ESS). Auto-CPAP patients used significantly more cm H2O. The long-term compliance of nCPAP therapy has have increased only slightly since the introduction of the fixed pressure CPAP 25 years ago, in spite of many efforts to improve it. It seems that a plateau has been reached and that it is unrealistic to aim at a substantially higher compliance rate.     

Comparative responsiveness of the EuroQol‐5D and Short Form 6D to improvement in patients with rheumatoid arthritis treated with tumor necrosis factor blockers: Results of the Dutch Rheumatoid Arthritis Monitoring registry

Objective

For cost‐utility analyses of health technologies, utilities are commonly measured with the EuroQol‐5D (EQ‐5D) or the Short Form 6D (SF‐6D). Although most studies in rheumatoid arthritis (RA) found the SF‐6D to be more responsive than the EQ‐5D, evidence is not convincing. The aim of this study was to compare the responsiveness of the EQ‐5D and SF‐6D to improvement in RA patients treated with tumor necrosis factor (TNF) blockers.

Methods

Data from 278 RA patients included in the Dutch Rheumatoid Arthritis Monitoring registry were used. Internal responsiveness over 1 year was evaluated by using standardized response means (SRMs). External responsiveness was evaluated by using receiver operating characteristic curves based on perceived health change (self‐reported health transition item Short Form 36) and change in disease activity (European League Against Rheumatism response criteria based on the Disease Activity Score in 28 joints).

Results

The scores of the EQ‐5D and SF‐6D changed moderately over 1 year (SRMs 0.50 and 0.67, respectively). The SF‐6D was significantly more responsive to treatment than the EQ‐5D. The EQ‐5D and SF‐6D were moderately able to correctly classify patients according to health transition (areas under the curve [AUCs] 0.67 and 0.72, respectively) and change in disease activity (AUCs 0.71 and 0.65, respectively).

Conclusion

The EQ‐5D and SF‐6D were only moderately responsive to improvement in RA patients treated with TNF blockers. Overall, the SF‐6D was more responsive than the EQ‐5D.     

Improved echo volumar imaging (EVI) for functional MRI

Echo volumar imaging (EVI) is a 3D modification of echo‐planar imaging (EPI) that allows data from an entire volume to be acquired following a single RF excitation. EVI provides a high rate of volumar data acquisition, which is advantageous for functional MRI (fMRI). However, few studies to date have applied EVI to fMRI, since because of gradient hardware limitations EVI generally has to be used with long sampling times, resulting in high sensitivity to susceptibility‐induced distortions. In this study we modified the EVI sequence to improve its suitability for fMRI. The sampling time is reduced by the use of a high gradient‐switching frequency, a small number of echoes, and outer volume suppression (OVS); rewind gradients ameliorate Nyquist ghosting; and phase correction via a calibration scan reduces ghosting and distortion. It is shown that the modified EVI sequence allows fMRI data to be acquired with a temporal resolution of 167 ms. Magn Reson Med, 2006. © 2006 Wiley‐Liss, Inc.     

Pitch accents in context: how listeners process accentuation in referential communication

We investigated whether listeners are sensitive to (mis)matching accentuation patterns with respect to contrasts in the linguistic and visual context, using Event-Related Potentials. We presented participants with displays of two pictures followed by a spoken reference to one of these pictures (e.g., “the red ball”). The referent was contrastive with respect to the linguistic context (utterance in the previous trial: e.g., “the blue ball”) or with respect to the visual context (other picture in the display; e.g., a display with a red ball and a blue ball). The spoken reference carried a pitch accent on the noun (“the red BALL”) or on the adjective (“the RED ball”), or an intermediate (‘neutral’) accentuation. For the linguistic context, we found evidence for the Missing Accent Hypothesis: Listeners showed processing difficulties, in the form of increased negativities in the ERPs, for missing accents, but not for superfluous accents. ‘Neutral’ or intermediate accents were interpreted as ‘missing’ accents when they occurred late in the referential utterance, but not when they occurred early. For the visual context, we found evidence for the Missing Accent Hypothesis for a missing accent on the adjective (an increase in negativity in the ERPs) and a superfluous accent on the noun (no effect). However, a redundant color adjective (e.g., in the case of a display with a red ball and a red hat) led to less processing problems when the adjective carried a pitch accent.     

Successfully living with chronic arthritis

The treatment and care of patients with rheumatoid arthritis (RA) is complex and various health professionals with different areas of expertise may be involved. The objective of this article is to review the treatments and their efficacy as provided by health care professionals in RA care. The requirements for further research in this area are formulated. To achieve better effects of treatment it is necessary to improve the coordination of services as provided by the different specialists. The important roles of the patients themselves in the care and management of the disease are emphasized, as well as the roles of the informal caregivers such as a spouse or other family members and friends and the role of patient societies. The possible role of the International Classification of Functioning, Disability and Health (ICF) to improve the communication and facilitate the coordination among health professionals and between patients and health professionals is mentioned. The topics presented in this article may encourage further discussion and research, particularly concerning the effects of the treatments as provided by allied health professionals. Health professionals play an important role in the life of patients with rheumatic disorders, in all the domains of the ICF: body functions and structure, activities (action by an individual) and participation (involvement in a life situation). Health professionals in rheumatology can make the difference in the lives of RA patients and their families.