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Legislative efforts for renewables-based energy decarbonisation hinge upon the support and commitment from different stakeholders holding often conflicting positions regarding disruptive processes of socio-technical transformation. However, the evolving acceptance of market actors on the policy-driven promotion of renewables over time remains under-scrutinised. Simultaneously, despite growing attention to power and politics in sustainability transitions, limited efforts remain invested for elucidating the political-economic nature of the market-based selection environments they are operationalised through, highlighting the need for a more systematic comprehension of the "politics of selection". To address these shortcomings, this paper provides a more refined understanding of the role of policy-driven markets and its participating agents in facilitating/hindering innovation diffusion and broader (system-wide) sustainability transitions. To do so, it showcases a longitudinal case study of the politics underlying Germany's evolving feed-in policy support framework for orchestrating a market-mediated diffusion of renewables (1980s–2020). Based on policy analysis and semi-structured interviews, the study traces the changing acceptance and ensuing strategic (re)actions of market actors to the emergence and evolution of Germany's market for electricity from renewable energy sources. Results show how different market participants effectively shape the selection environments they operate in by proactively contesting/deluding the design features of the support policies organising their economised relations (e.g., market entry conditions, exchange rules, remuneration levels, pricing schemes, etc.). Such efforts are undertaken through legal means and market framing strategies targeting the affordability of policy support costs, coupled with the strategic use of policy instrumentation as a vehicle to further expand/retain their market shares to the detriment of competing actors. [ABSTRACT FROM AUTHOR]

Background: Managing older people in the emergency department remains a challenge. We aimed to identify the factors influencing the care quality of older patients in the emergency department, to fine-tune future interventions for older people, considering the naturalistic context of the ED.Methods: This is a qualitative study of some 450 h of observations performed in three emergency departments selected for their diverse contexts. We performed seventy observations of older patient trajectories admitted to the emergency department. Themes were extracted from the material using an inductive reasoning approach, to highlight factors positively or negatively influencing management of patient's trajectories, in particular those presenting with typically geriatric syndromes.Results: Four themes were developed: no geriatric flow routine; risk of discontinuity of care; unmet basic needs and patient-centered care; complex older patients are unwelcome in EDs.Conclusions: The overall process of care was based on an organ- and flow-centered paradigm, which ignored older people's specific needs and exposed them to discontinuity of care. Their basic needs were neglected and, when their management slowed the emergency department flow, older people were perceived as unwelcome. Findings of our study can inform the development of interventions about the influence of context and organizational factors. [ABSTRACT FROM AUTHOR]

Marine management areas provide a key tool for efforts towards sustainable development, reconciling socio-economic goals with those for biodiversity conservation. Decisions about where and when to establish spatial management areas in the oceans are currently hampered by the uncertainties of incomplete, or overly general, information about biodiversity. The analysis of environmental DNA (eDNA) provides a potentially powerful tool to overcome this lack of data in the future. Here we present directions to develop robust approaches to integrate eDNA and spatial planning processes, aiming to provide guidance to underpin tool development. The potential of eDNA use in conservation is widely recognised, although direct applications almost exclusively focus on detection of invasive or threatened species and not spatial management decisions. The implementation of broader interaction between the fields of conservation science and eDNA analysis could create substantial benefits to biodiversity conservation and management. In particular, eDNA analysis can provide information on biodiversity over spatial-temporal scales that are currently prohibitive in spatial planning studies. Here, we provide an overview of how eDNA is currently used in conservation practice, in addition to understanding its limitations and benefits within the context of spatial planning. With the goal to harness rapid technological developments in both molecular and conservation sciences, we provide a horizon scan of the future of eDNA analysis and its application to inform biodiversity conservation in a rapidly changing world. [ABSTRACT FROM AUTHOR]

Abstract Cryptobenthic fishes play a crucial role in marine ecosystems as trophic links between the base of the food chain and higher-level consumers. Infralittoral soft sediments are the largest marine habitat, yet little is known about fish assemblages in these ecosystems. This study investigates the cryptobenthic fish abundance and diversity on soft sediment habitats in the centre of tropical marine biodiversity. We surveyed 20 sites across three regions in Indonesia (Bali, Lembeh Strait) and the Philippines (Dauin) using Underwater Visual Surveys (UVC) and roving diver surveys. We tested the effects of depth (6 m, 16 m), benthic cover and sediment grain size characteristics on fish assemblages. Our results showed a high diversity (112 species), but low abundances (mean: 93 individuals/500 m2 ± SE: 28 ind.). Benthic cover on surveyed sites consisted for 90.1% (±SE: 0.7%) of unconsolidated sediments, which were predominantly poorly sorted (σ = 0.975 φ), gravelly sand. PERMANOVA analyses showed that fish assemblages and fish diversity was significantly different between regions (p < 0.001) and depth (p = 0.002). Distance based linear Models (DistLM) explained respectively 25% and 33.5% of the variation in fish assemblages and fish diversity. The high cryptobenthic fish diversity found in this study exceeds that of many coral reefs and contradicts the current view of soft sediment fish communities as depauparate ones. Our results provide valuable insights in a poorly studied marine ecosystem and call for more research in these valuable habitats. Highlights • First study of cryptobenthic fishes on soft sediment in Southeast Asia. • Soft sediment showed high fish species diversity, but low abundance. • Grain size and benthic cover were important drivers of fish assemblages. • Results challenge current views of fish communities on soft sediment habitats. [ABSTRACT FROM AUTHOR]

Environmental DNA (eDNA) metabarcoding has the potential to revolutionize conservation planning by providing spatially and taxonomically comprehensive data on biodiversity and ecosystem conditions, but its utility to inform the design of protected areas remains untested. Here, we quantify whether and how identifying conservation priority areas within coral reef ecosystems differs when biodiversity information is collected via eDNA analyses or traditional visual census records. We focus on 147 coral reefs in Indonesia's hyper-diverse Wallacea region and show large discrepancies in the allocation and spatial design of conservation priority areas when coral reef species were surveyed with underwater visual techniques (fishes, corals, and algae) or eDNA metabarcoding (eukaryotes and metazoans). Specifically, incidental protection occurred for 55% of eDNA species when targets were set for species detected by visual surveys and 71% vice versa. This finding is supported by generally low overlap in detection between visual census and eDNA methods at species level, with more overlap at higher taxonomic ranks. Incomplete taxonomic reference databases for the highly diverse Wallacea reefs, and the complementary detection of species by the two methods, underscore the current need to combine different biodiversity data sources to maximize species representation in conservation planning. [ABSTRACT FROM AUTHOR]

Scuba diving tourism is a sustainable source of income for many coastal communities, but can have negative environmental impacts if not managed effectively. Diving on soft sediment habitats, typically referred to as ‘muck diving’, is a growing multi-million dollar industry with a strong focus on photographing cryptobenthic fauna. We assessed how the environmental impacts of scuba divers are affected by the activity they are engaged in while diving and the habitat they dive in. To do this, we observed 66 divers on coral reefs and soft sediment habitats in Indonesia and the Philippines. We found diver activity, specifically interacting with and photographing fauna, causes greater environmental disturbances than effects caused by certification level, gender, dive experience or age. Divers touched the substrate more often while diving on soft sediment habitats than on coral reefs, but this did not result in greater environmental damage on soft sediment sites. Divers had a higher impact on the substrate and touch animals more frequently when observing or photographing cryptobenthic fauna. When using dSLR-cameras, divers spent up to five times longer interacting with fauna. With the unknown, long-term impacts on cryptobenthic fauna or soft sediment habitats, and the increasing popularity of underwater photography, we argue for the introduction of a muck diving code of conduct. [ABSTRACT FROM AUTHOR]

Abstract: As ecosystems come under increasing anthropogenic pressure, rare species face the highest risk of extinction. Paradoxically, data necessary to evaluate the conservation status of rare species are often lacking because of the challenges of detecting species with low abundance. One group of fishes subject to this undersampling bias are those with cryptic body patterns. Twenty‐one percent of cryptic fish species assessed for their extinction risk (International Union for Conservation of Nature [IUCN]) are data deficient. We developed a nondestructive method for surveying cryptically patterned marine fishes based on the presence of biofluorescence (underwater biofluorescence census, UBC). Blue LED torches were used to investigate how widespread biofluorescence was in cryptic reef fishes in the Coral Triangle region. The effectiveness of UBC to generate abundance data was tested on a data‐deficient pygmy seahorse species (Hippocampus bargibanti) and compared with data obtained from standard underwater visual census (UVC) surveys. We recorded 95 reef fish species displaying biofluorescence, 73 of which had not been previously described as biofluorescent. Of those fish with cryptic patterns, 87% were biofluorescent compared with 9% for noncryptic fishes. The probability of species displaying biofluorescence was 70.9 times greater for cryptic species than for noncryptic species. Almost twice the number of H. bargibanti was counted using the UBC compared with UVC. For 2 triplefin species (Ucla xenogrammus, Enneapterygius tutuilae), the abundance detected with UBC was triple that detected with UVC. The UBC method was effective at finding cryptic species that would otherwise be difficult to detect and thus will reduce interobserver variability inherent to UVC surveys. Biofluorescence is ubiquitous in cryptic fishes, making this method applicable across a wide range of species. Data collected using UBC could be used with multiple IUCN criteria to assess the extinction risk of cryptic species. Adopting this technique will enhance researchers’ ability to survey cryptic species and facilitate management and conservation of cryptic marine species. [ABSTRACT FROM AUTHOR]

Study Objective: In the present study, we evaluated the leukocyte esterase (LE) area of a reagent strip designed for urinalysis for the semiquantitative measurement of the percentage of polymorphonuclear neutrophils (PMNs) in BAL fluid.Design: Prospective. The relative PMN counts (obtained by conventional microscopy and expressed as a percentage of a 500 cell count) of consecutive BAL fluid samples were compared with the corresponding LE categories as read with a urine chemistry reader. LE categories were graded as follows: negative, trace, +, + +, and + + +.Results: A total of 153 BAL fluid samples were included. The mean PMN counts of the negative LE category (4.1 +/- 4.3%; n = 43) and the + + + category (81.8 +/- 16.3%; n = 37) differed significantly from each other and from the mean PMN counts of the other categories. Within the trace, +, and + + categories, a considerable overlap of PMN counts was noted. Assignment of a BAL fluid to the negative LE category consistently predicted a PMN count < 20%. At a threshold value of 50% PMNs, the + + + LE category predicted the BAL fluid samples to the correct group (PMNs > 50% vs < 50%) with a sensitivity of 70.8% and a specificity of 97.1%.Conclusions: The reagent strips proved to be useful as a rapid test for semiquantitative measurement of the relative PMN counts in BAL fluid. However, the low predictive value for the exclusion of a high PMN count may limit their application. [ABSTRACT FROM AUTHOR]

Highlights: [•] The medical and geriatric characteristics of hospitalized older people are evolving even in a short period. [•] Older patients with more complex problems and significant functional issues present a specific challenge. [•] Interventions should be developed to make the most of existing resources. [Copyright &y& Elsevier]

The authors investigated the performance on simple multiplication and division problems of 8-year-old children longitudinally to determine the developmental trajectories of both operations. Twice a year, during 2 consecutive school years, children performed a multiplication and division verification task and a number-matching task. All effects that were observed in multiplication performance (problem size, 5, and tie effect and Tie X Size interaction) were also observed in division performance. The developmental trajectories of these effects are described. The authors observed strong developmental parallels between both operations. These results are in line with strongly interconnected memory networks for multiplication and division facts, at least in young children. The results of the number-matching task showed that the interference effect developed differently for multiplication and division, indicating that automatic activation spreading from division operands to division answers is not at work in children of that age. [ABSTRACT FROM AUTHOR]

We present new evidence that word translation involves semantic mediation. It has been shown that participants react faster to small numbers with their left hand and to large numbers with their right hand. This SNARC (spatial-numerical association of response codes) effect is due to the fact that in Western cultures the semantic number line is oriented from left (small) to right (large). We obtained a SNARC effect when participants had to indicate the parity of second-language (L2) number words, but not when they had to indicate whether L2 number words contained a particular sound. Crucially, the SNARC effect was also obtained in a translation verification task, indicating that this task involved the activation of number magnitude. [ABSTRACT FROM AUTHOR]

The use of concentrated platelet-rich plasma (cPRP) as a source of growth factors is reported to be beneficial for an enhanced osteogenesis in spine surgery. Today both bovine and autologous thrombin is used for activating the platelets and thus releasing the growth factors. In order to prevent transmission of organisms and the development of antibodies, autologous thrombin seems to be the logical choice. However, the preparation of autologous thrombin is cumbersome and consumes a part of the cPRP. In order to overcome this problem, a commercial autologous thrombin kit (activAT, Dideco, a Sorin Group company, Italy) has been developed which produces autologous thrombin out of platelet-poor plasma. A possible disadvantage of this kit could be the rest fraction of 1.18% of ethanol in the platelet gel. In a pig model, the influence of different ethanol concentrations on the ischiadic nerve was studied. The study consisted out of four groups; a control group ( n=6), a group with platelet gel 0% ethanol ( n=6), a group with platelet gel 1.18% ethanol ( n=6) and a group with platelet gel 3.8% ethanol ( n=7). In all the groups, the ischiadic nerve was dissected and the myelin sheet opened after which the wound was closed (control group) or one of the three therapies was applied. After 12 h, the animal was sacrificed and the ischiadic nerve was submitted for histological examination. Myelin sheaths appeared normal in all cases. No axonal swelling was observed. No statistically significant differences were observed for neutrophilic and eosinophilic infiltration nor for collagen necrosis between groups. Platelet gel prepared by the use of a commercial autologous thrombin kit and containing 1.18% of ethanol can be safely used on nerves. [ABSTRACT FROM AUTHOR]

Poly(lactic acid)-poly(hydroxybutyrate) (PLA-PHB)-based nanocomposite films were prepared with bio-based additives (CNCs and ChNCs) and oligomer lactic acid (OLA) compatibilizer using extrusion and then blown to films at pilot scale. The aim was to identify suitable material formulations and nanocomposite production processes for film production at a larger scale targeting food packaging applications. The film-blowing process for both the PLA-PHB blend and CNC-nanocomposite was unstable and led to non-homogeneous films with wrinkles and creases, while the blowing of the ChNC-nanocomposite was stable and resulted in a smooth and homogeneous film. The optical microscopy of the blown nanocomposite films indicated well-dispersed chitin nanocrystals while the cellulose crystals were agglomerated to micrometer-size particles. The addition of the ChNCs also resulted in the improved mechanical performance of the PLA-PHB blend due to well-dispersed crystals in the nanoscale as well as the interaction between biopolymers and the chitin nanocrystals. The strength increased from 27 MPa to 37 MPa compared to the PLA-PHB blend and showed almost 36 times higher elongation at break resulting in 10 times tougher material. Finally, the nanocomposite film with ChNCs showed improved oxygen barrier performance as well as faster degradation, indicating its potential exploitation for packaging applications. [ABSTRACT FROM AUTHOR]

In 2018, the real amount invested in the European Union's energy transition fell short of the funding level required to reach the 2030 climate and energy targets by €179 billion. Citizen-led finance in renewable energy development emerges as an innovative tool to bridge this investment gap. However, in spite of the European Union's ambition to involve local communities for co-driving the low-carbon energy transition, there is no comprehensive analysis quantifying citizens' potential to co-finance and participate in community renewable energy initiatives across Europe. We address this knowledge gap through a representative choice experiment survey that collected responses from 16,235 participants to different hypothetical investment options on renewable energy schemes across all European Union Member States, and estimate the social potential of European citizens to participate and invest in community-administered wind farms. Results from a novel survey-based social simulation indicate that €176 billion could be obtained from citizen-led finance in community-administered wind farm developments, enough to halve the investment gap to achieve a 32% renewable energy share in final energy consumption by 2030. Our analysis substantiates the case for facilitating easily accessible, risk-insured community investment options across Europe to unlock citizens' social potential for investing in community renewable energy. • Citizens emerge as a legitimate actor for co-driving Europe's energy transition. • Over €176 billion potentially available to co-finance community-based wind energy. • Novel 'survey-based social simulation' (SBSS) used on choice experiment responses. • Risk-insured community investment options needed to unlock citizens' social potential. • Policy measures should incentivise citizen participation in renewable energy to foster social acceptance. [ABSTRACT FROM AUTHOR]

The article cites cases of laboratory-acquired meticillin-resistant Staphylococcus aureus infection in the Netherlands. Decolonization treatment was administered using mupirocin nose ointment and povidone iodine scrub, consultation with an ear, nose and throat specialist. Results revealed that meticillin-resistant staphylococcus aureus bacteria colonizes the nose and throat of its host. In response to the incidents, the following were decided: intensification of cleaning and disinfection and application of universal precautionary measures.

Background: Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED's role in providing palliative care for this population. Methods: We designed a qualitative study based on 1) interviews – conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis. Results: Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients'(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED's role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile. Conclusions: Currently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier. [ABSTRACT FROM AUTHOR]

Millions of people take animal pictures during wildlife interactions, yet the impacts of photographer behaviour and photographic flashes on animals are poorly understood. We investigated the pathomorphological and behavioural impacts of photographer behaviour and photographic flashes on 14 benthic fish species that are important for scuba diving tourism and aquarium displays. We ran a field study to test effects of photography on fish behaviour, and two laboratory studies that tested effects of photographic flashes on seahorse behaviour, and ocular and retinal anatomy. Our study showed that effects of photographic flashes are negligible and do not have stronger impacts than those caused solely by human presence. Photographic flashes did not cause changes in gross ocular and retinal anatomy of seahorses and did not alter feeding success. Physical manipulation of animals by photographing scuba divers, however, elicited strong stress responses. This study provides important new information to help develop efficient management strategies that reduce environmental impacts of wildlife tourism. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented in response to the article regarding studies on preventing the spread of the nosocomial spread of methicillin-resistant "Staphylococcus aureus" in an Intensive Care Unit.

Background: Measuring quality is essential to drive improvement initiatives in hospitals. An instrument that measures healthcare quality multidimensionally and integrates patients', kin's and professionals' perspectives is lacking. We aimed to develop and validate an instrument to measure healthcare quality multidimensionally from a multistakeholder perspective. Methods: A multi-method approach started by establishing content and face validity, followed by a multi-centre study in 17 Flemish (Belgian) hospitals to assess construct validity through confirmatory factor analysis, criterion validity through determining Pearson's correlations and reliability through Cronbach's alpha measurement. The instrument FlaQuM-Quickscan measures 'Healthcare quality for patients and kin' (part 1) and 'Healthcare quality for professionals' (part 2). This bipartite instrument mirrors 15 quality items and 3 general items (the overall quality score, recommendation score and intention-to-stay score). A process evaluation was organised to identify effective strategies in instrument distribution by conducting semi-structured interviews with quality managers. Results: By involving experts in the development of quality items and through pilot testing by a multi-stakeholder group, the content and face validity of instrument items was ensured. In total, 13,615 respondents (5,891 Patients/kin and 7,724 Professionals) completed the FlaQuM-Quickscan. Confirmatory factor analyses showed good to very good fit and correlations supported the associations between the quality items and general items for both instrument parts. Cronbach's alphas supported the internal consistency. The process evaluation revealed that supportive technical structures and approaching respondents individually were effective strategies to distribute the instrument. Conclusions: The FlaQuM-Quickscan is a valid instrument to measure healthcare quality experiences multidimensionally from an integrated multistakeholder perspective. This new instrument offers unique and detailed data to design sustainable quality management systems in hospitals. Based on these data, hospital management and policymakers can set quality priorities for patients', kin's and professionals' care. Future research should investigate the transferability to other healthcare systems and examine between-stakeholders and between-hospitals variation. [ABSTRACT FROM AUTHOR]

Background: Older patients are increasingly showing multi-comorbidities, including advanced chronic diseases. When admitted to the emergency department (ED), the decision to pursue life-prolonging treatments or to initiate a palliative care approach is a challenge for clinicians. We test for the first time the diagnostic accuracy of the Supportive and Palliative Care Indicators Tool (SPICT) in the ED to identify older patients at risk of deteriorating and dying, and timely address palliative care needs. Methods: We conducted a prospective bicentric cohort study on 352 older patients (≥ 75 years) admitted to two EDs in Belgium between December 2019 and March 2020 and between August and November 2020. SPICT (French version, 2019) variables were collected during the patients' admission to the ED, along with socio-demographic, medical and functional data. The palliative profile was defined as a positive SPICT assessment. Survival, symptoms and health degradation (≥ 1 point in ADL Katz score or institutionalisation and death) were followed at 12 months by phone. Main accuracy measures were sensitivity, specificity and likelihood ratios (LR) as well as cox regression, survival analysis using the Kaplan Meier method, and ordinal regression. Results: Out of 352 patients included in the study (mean age 83 ± 5.5 years, 43% male), 167 patients (47%) had a positive SPICT profile. At one year follow up, SPICT positive patients presented significantly more health degradation (72%) compared with SPICT negative patients (35%, p < 0.001). SPICT positivity was correlated with 1-year health degradation (OR 4.9; p < 0.001). The sensitivity and specificity of SPICT to predict health degradation were 0.65 (95%CI, 0.57–0.73) and 0.72 (95%CI, 0.64–0.80) respectively, with a negative LR of 0.48 (95%CI, 0.38–0.60) and a positive LR of 2.37 (1.78–3.16). The survival time was shorter in SPICT positive patients than in SPICT negative ones (p < 0.001), the former having a higher 1-year mortality rate (HR = 4.21; p < 0.001). Conclusions: SPICT successfully identifies older patients at high risk of health degradation and death. It can support emergency clinicians to identify older patients with a palliative profile and subsequently initiate a palliative care approach with a discussion on goals of care. [ABSTRACT FROM AUTHOR]

We determined the prevalence and spread of antibiotic resistance and the characteristics of ESBL producing and/or multi drug resistant (MDR) Escherichia coli isolates collected from urine samples from urology services in the Euregio Meuse-Rhine, the border region of the Netherlands (n = 176), Belgium (n = 126) and Germay (n = 119). Significant differences in resistance between the three regions were observed. Amoxicillin-clavulanic acid resistance ranged from 24% in the Netherlands to 39% in Belgium (p = 0.018), from 20% to 40% (p<0.004) for the fluoroquinolones and from 20% to 40% (p = 0.018) for the folate antagonists. Resistance to nitrofurantoin was less than 5%. The prevalence of ESBL producing isolates varied from 2% among the Dutch isolates to 8% among the German ones (p = 0.012) and were mainly CTX-M 15. The prevalence of MDR isolates among the Dutch, German and Belgian isolates was 11%, 17% and 27%, respectively (p<= 0.001 for the Belgian compared with the Dutch isolates). The majority of the MDR and ESBL producing isolates belonged to ST131. This study indicates that most antibiotics used as first choice oral empiric treatment for UTIs (amoxicillin-clavulanic acid, fluoroquinolones and folate antagonists) are not appropriate for this purpose and that MDR strains such as CTX-M producing ST131 have spread in the entire Euregion. Our data stress the importance of ward specific surveillance to optimize empiric treatment. Also, prudent use of antibiotics and further research to alternative agents are warranted. [ABSTRACT FROM AUTHOR]

Until now, error and conflict adaptation have been studied extensively using simple laboratory tasks. A common finding is that responses slow down after errors. According to the conflict monitoring theory, performance should also improve after an error. However, this is usually not observed. In this study, we investigated whether the characteristics of the experimental paradigms normally used could explain this absence. More precisely, these paradigms have in common that behavioural adaptation has little room to be expressed. We therefore studied error and conflict adaptation effects in a task that encounters the richness of everyday life's behavioural adaptation—namely, mental arithmetic, where multiple solution strategies are available. In accordance with our hypothesis, we observed that posterror accuracy increases after errors in mental arithmetic. No support for conflict adaptation in mental arithmetic was found. Implications for current theories of conflict and error monitoring are discussed. [ABSTRACT FROM PUBLISHER]

This study focuses on the use of pilot-scale produced polyhydroxy butyrate (PHB) biopolymer and chitin nanocrystals (ChNCs) in two different concentrated (1 and 5 wt.%) nanocomposites. The nanocomposites were compounded using a twin-screw extruder and calendared into sheets. The crystallization was studied using polarized optical microscopy and differential scanning calorimetry, the thermal properties were studied using thermogravimetric analysis, the viscosity was studied using a shear rheometer, the mechanical properties were studied using conventional tensile testing, and the morphology of the prepared material was studied using optical microscopy and scanning electron microscopy. The results showed that the addition of ChNCs significantly affected the crystallization of PHB, resulting in slower crystallization, lower overall crystallinity, and smaller crystal size. Furthermore, the addition of ChNCs resulted in increased viscosity in the final formulations. The calendaring process resulted in slightly aligned sheets and the nanocomposites with 5 wt.% ChNCs evaluated along the machine direction showed the highest mechanical properties, the strength increased from 24 to 33 MPa, while the transversal direction with lower initial strength at 14 MPa was improved to 21 MPa. [ABSTRACT FROM AUTHOR]

Group A beta hemolytic streptococci (GAS) can cause a wide range of mild infections but they are associated with severe infections with high morbidity and mortality rates. Risk factors for invasive GAS infections in children include antecedent varicella zoster infection. There is an increasing incidence of invasive GAS infection caused by clonal strains leading to outbreaks in the last decade. We describe four pediatric patients with severe conditions caused by GAS, leading to intensive care support in two patients. Two of the patients had antecedent varicella infection. A single clone of group A streptococcus was responsible in all children. Routine varicella vaccination is not currently part of the health programs of many countries, including The Netherlands. One benefit of universal varicella vaccination would be the prevention of some cases of pediatric invasive GAS disease, leading to a decrease in hospitalization, morbidity and mortality rates. [ABSTRACT FROM AUTHOR]

The mechanism of syndiospecific polymerization with (η5-C5H4-CMe2-η5-C13H8) MCl2; M=Zr, Hf/MAO catalyst systems is discussed by taking into account the structural characteristics of the metallocene molecules and the chiral particularities of their cationic species within the framework of a chain migratory insertion mechanism. A generally accepted transition state structure that respects the relative importance of different steric interactions of the active participants in the polymerization process, ligand, growing polymer chain and the coordinating monomer is proposed. The model is reexamined on the basis of an isotactic specific (η5-C5H3C4H9-CMe2-η5-C13H8)ZrCl2/MAO and a recently discovered syndiotactic specific catalyst system, η1,η5-tert-butyl(3,6- bis-tert-butylfluorenyl-dimethylsilyl)amidoMCl2/MAO; M=Zr, Ti and its validity is confirmed. [Copyright &y& Elsevier]

A new species and the first confirmed record of a true pygmy seahorse from Africa, Hippocampus nalu sp. nov., is herein described on the basis of two specimens, 18.9-22 mm SL, collected from flat sandy coral reef at 14-17 meters depth from Sodwana Bay, South Africa. The new taxon shares morphological synapomorphies with the previously described central Indo-Pacific pygmy seahorses, H. colemani, H. japapigu, H. pontohi, and H. satomiae, and H. waleananus, including diminutive size, twelve trunk rings, prominent cleithral ring and supracleithrum, spines on the fifth and twelfth superior and lateral trunk ridges, respectively, and prominent wing-like protrusions present on the first and/or second superior trunk rings posterior to the head. Hippocampus nalu sp. nov. is primarily distinguished from its pygmy seahorse congeners by highly distinct spine morphology along the anterior segments of the superior trunk ridge. Comparative molecular analysis reveals that the new species demonstrates significant genetic divergence in the mitochondrial COI gene from the morphologically similar H. japapigu and H. pontohi (estimated uncorrected p-distances of 16.3% and 15.2%, respectively). Hippocampus nalu sp. nov. represents the eighth member of the pygmy seahorse clade to be described from the Indo-Pacific, the first confirmed record from the African continent and the Indian Ocean, and an extension of more than 8000 km beyond the previously known range of pygmy seahorses from the Central and Western Indo-Pacific. [ABSTRACT FROM AUTHOR]

Loss of biodiversity from lower to upper trophic levels reduces overall productivity and stability of coastal ecosystems in our oceans, but rarely are these changes documented across both time and space. The characterisation of environmental DNA (eDNA) from sediment and seawater using metabarcoding offers a powerful molecular lens to observe marine biota and provides a series of 'snapshots' across a broad spectrum of eukaryotic organisms. Using these next-generation tools and downstream analytical innovations including machine learning sequence assignment algorithms and co-occurrence network analyses, we examined how anthropogenic pressures may have impacted marine biodiversity on subtropical coral reefs in Okinawa, Japan. Based on 18 S ribosomal RNA, but not ITS2 sequence data due to inconsistent amplification for this marker, as well as proxies for anthropogenic disturbance, we show that eukaryotic richness at the family level significantly increases with medium and high levels of disturbance. This change in richness coincides with compositional changes, a decrease in connectedness among taxa, an increase in fragmentation of taxon co-occurrence networks, and a shift in indicator taxa. Taken together, these findings demonstrate the ability of eDNA to act as a barometer of disturbance and provide an exemplar of how biotic networks and coral reefs may be impacted by anthropogenic activities. [ABSTRACT FROM AUTHOR]

Background: Use of single-bed rooms for control of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae is under debate; the added value when applying contact precautions has not been shown. We aimed to assess whether an isolation strategy of contact precautions in a multiple-bed room was non-inferior to a strategy of contact precautions in a single-bed room for preventing transmission of ESBL-producing Enterobacteriaceae.Methods: We did a cluster-randomised, crossover, non-inferiority study on medical and surgical wards of 16 Dutch hospitals. During two consecutive study periods, either contact precautions in a single-bed room or contact precautions in a multiple-bed room were applied as the preferred isolation strategy for patients with ESBL-producing Enterobacteriaceae cultured from a routine clinical sample (index patients). Eligible index patients were aged 18 years or older, had no strict indication for barrier precautions in a single-bed room, had a culture result reported within 7 days of culture and before discharge, and had no wardmate known to be colonised or infected with an ESBL-producing Enterobacteriaceae isolate of the same bacterial species with a similar antibiogram. Hospitals were randomly assigned in a 1:1 ratio by computer to one of two sequences of isolation strategies, stratified by university or non-university hospital. Allocation was masked for laboratory technicians who assessed the outcomes but not for patients, treating doctors, and infection-control practitioners enrolling index patients. The primary outcome was transmission of ESBL-producing Enterobacteriaceae to wardmates, which was defined as rectal carriage of an ESBL-producing Enterobacteriaceae isolate that was clonally related to the index patient's isolate in at least one wardmate. The primary analysis was done in the per-protocol population, which included patients who were adherent to the assigned room type. A 10% non-inferiority margin for the risk difference was used to assess non-inferiority. This study is registered with Nederlands Trialregister, NTR2799.Findings: 16 hospitals were randomised, eight to each sequence of isolation strategies. All hospitals randomised to the sequence single-bed room then multiple-bed room and five of eight hospitals randomised to the sequence multiple-bed room then single-bed room completed both study periods and were analysed. From April 24, 2011, to Feb 27, 2014, 1652 index patients and 12 875 wardmates were assessed for eligibility. Of those, 693 index patients and 9527 wardmates were enrolled and 463 index patients and 7093 wardmates were included in the per-protocol population. Transmission of ESBL-producing Enterobacteriaceae to at least one wardmate was identified for 11 (4%) of 275 index patients during the single-bed room strategy period and for 14 (7%) of 188 index patients during the multiple-bed room strategy period (crude risk difference 3·4%, 90% CI -0·3 to 7·1).Interpretation: For patients with ESBL-producing Enterobacteriaceae cultured from a routine clinical sample, an isolation strategy of contact precautions in a multiple-bed room was non-inferior to a strategy of contact precautions in a single-bed room for preventing transmission of ESBL-producing Enterobacteriaceae. Non-inferiority of the multiple-bed room strategy might change the current single-bed room preference for isolation of patients with ESBL-producing Enterobacteriaceae and, thus, broaden infection-control options for ESBL-producing Enterobacteriaceae in daily clinical practice.Funding: Netherlands Organisation for Health Research and Development. [ABSTRACT FROM AUTHOR]

Amphiprion tricinctus is an anemonefish endemic to the Marshall Islands that was previously reported to inhabit four species of sea anemone. Underwater visual surveys in 2009 and 2010 located five individuals of the anemone Stichodactyla haddoni in the shallow lagoon of Majuro Atoll. This is the first record of S. haddoni in the Marshall Islands and a significant north-eastern range extension by 2200 km from its nearest record in Chuuk State, Federated States of Micronesia. Stichodactyla haddoni was inhabited by juvenile and adult A. tricinctus. This report is the first to describe a symbiotic relationship between A tricinctus and S. haddoni. The number of host anemone species inhabited by A. tricinctus now extends to five. [ABSTRACT FROM PUBLISHER]

Background Using data from an observational study in which the effectiveness of a guideline for eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage was evaluated, we identified variables that were associated with treatment failure. Methods A multivariate logistic regression model was performed with subgroup analyses for uncomplicated and complicated MRSA carriage (the latter including MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and for those treated according to the guideline (i.e. mupirocin nasal ointment and chlorhexidine soap solution for uncomplicated carriage, in combination with two oral antibiotics for complicated carriage). Results Six hundred and thirteen MRSA carriers were included, of whom 333 (54%) had complicated carriage; 327 of 530 patients (62%) with known complexity of carriage were treated according to the guideline with an absolute increase in treatment success of 20% (95% confidence interval 12%–28%). Among those with uncomplicated carriage, guideline adherence [adjusted odds ratio (ORa) 7.4 (1.7–31.7)], chronic pulmonary disease [ORa 44 (2.9–668)], throat carriage [ORa 2.9 (1.4–6.1)], perineal carriage [ORa 2.2 (1.1–4.4)] and carriage among household contacts [ORa 5.6 (1.2–26)] were associated with treatment failure. Among those with complicated carriage, guideline adherence was associated with treatment success [ORa 0.2 (0.1–0.3)], whereas throat carriage [ORa 4.4 (2.3–8.3)] and dependence in activities of daily living [ORa 3.6 (1.4–8.9)] were associated with failure. Conclusions Guideline adherence, especially among those with complicated MRSA carriage, was associated with treatment success. Adding patients with extranasal carriage or dependence in daily self-care activities to the definition of complicated carriage, and treating them likewise, may further increase treatment success. [ABSTRACT FROM PUBLISHER]

Background We evaluated the effectiveness of eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage in the Netherlands after the introduction of a guideline in 2006. The guideline distinguishes complicated (defined as the presence of MRSA infection, skin lesions, foreign-body material, mupirocin resistance and/or exclusive extranasal carriage) and uncomplicated carriage (not meeting criteria for complicated carriage). Mupirocin nasal ointment and chlorhexidine soap solution are recommended for uncomplicated carriers and the same treatment in combination with two oral antibiotics for complicated carriage. Methods A prospective cohort study was performed in 18 Dutch centres from 1 October 2006 until 1 October 2008. Results Six hundred and thirteen MRSA carriers underwent one or more decolonization treatments during the study period, mostly after hospital discharge. Decolonization was achieved in 367 (60%) patients with one eradication attempt and ultimately 493 (80%) patients were decolonized, with a median time until decolonization of 10 days (interquartile range 7–43 days). Three hundred and twenty-seven (62%) carriers were treated according to the guideline, which was associated with an absolute increase in treatment success of 20% [from 45% (91/203) to 65% (214/327)]. Conclusions Sixty percent of MRSA carriers were successfully decolonized after the first eradication attempt and 62% were treated according to the guideline, which was associated with an increased treatment success. [ABSTRACT FROM PUBLISHER]

Because the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs among the 3 countries forming the Euregio Meuse-Rhin (EMR) region (Belgium, Germany, and the Netherlands), cross-border healthcare requires information about the spread of MRSA in the EMR. We investigated the emergence, dissemination, and diversity of MRSA clones in the EMR by using several typing methods. MRSA associated with clonal complexes 5, 8, 30, and 45 was disseminated throughout the EMR. Dutch isolates, mainly associated with sequence types (ST) ST5-MRSA-II, ST5-MRSA-IV, ST8-MRSA-IV, and ST45-MSRAIV had a more diverse genetic background than the isolates from Belgium and Germany, associated with ST45-MRSAIV and ST5-MRSA-II, respectively. MRSA associated with pigs (ST398-MRSA-IV/V) was found in the Dutch area of the EMR. Five percent of the MRSA isolates harbored Panton-Valentine leukocidin and were classified as communityassociated MRSA associated with ST1, 8, 30, 80, and 89. [ABSTRACT FROM AUTHOR]

The aim of the study presented here was to evaluate an enrichment broth-enhanced commercial PCR procedure for excluding the presence of meticillin-resistant Staphylococcus aureus (MRSA) in patient samples in less than 36 h. In The Netherlands to date, all MRSA epidemics have been successfully controlled with the Dutch search-and-destroy policy. However, PCR facilitates more rapid screening for MRSA than traditional culture. One commercial PCR option is the hyplex StaphyloResist® PCR assay (Biologische Analysensystem GmbH, Lich, Germany), which detects Staphylococcus aureus and the mecA gene in MRSA as well as in coagulase-negative staphylococci (CoNS). This assay was used to test a total of 939 specimens obtained from 346 individuals. Following resolution of all discrepancies, the prevalence, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for all separate specimens were 9.0, 97.6, 83.7, 37.4 and 99.7%, respectively, and for specimens grouped according to daily episode submitted per individual, they were 7.5, 97.4, 77.2, 26.2 and 99.7%, respectively. These results led to the introduction of this PCR into the hospital laboratory’s routine for the purpose outlined above. [ABSTRACT FROM AUTHOR]

An increase in the number of outbreaks of Acinetobacter infection was notified in The Netherlands during 1999–2001. The present study compared the outbreaks at the species and strain levels, and analysed the epidemiology and control measures at the different locations. For each institute, three representative isolates from three patients were identified to the species and strain levels by genotyping methods. A questionnaire investigated the impact of the outbreak, the control measures that were taken, and the possible effects of the measures. Seven outbreaks were associated with Acinetobacter baumannii (three outbreaks with a strain designated strain A, two outbreaks with a strain designated strain B, and one outbreak each with strains designated C and D). An additional outbreak was caused by genomic species 13TU, which is related closely to A. baumannii. Strains B and D were identified as European clones III and II, respectively. Except for two hospitals with outbreaks caused by strain A, there was no known epidemiological link between the participating hospitals. In all hospitals the outbreak occurred on one or several intensive care units, and spread to other departments was noted in two hospitals. The number of patients affected ranged from six to 66 over a period of 2–22 months. In most outbreaks, patients were the likely reservoir from which spread occurred. In all hospitals, a large panel of measures was required to bring the outbreak to an end. Extensive environmental sampling yielded numerous positive samples in most but not all hospitals. [ABSTRACT FROM AUTHOR]

We aimed to establish an explicit list of potentially clinically significant drug-drug interactions (DDIs) in people aged ≥65 years. A preliminary list of potentially clinically significant DDIs was compiled, based on 154 DDIs identified from literature review. Subsequently, a 2-round online Delphi survey was undertaken with a multidisciplinary expert panel. A consensus meeting and a final round were conducted to validate the final DDI list and the scope of information provided. Twenty nine experts, including geriatricians and clinical pharmacists from 8 European countries. For each DDI, in the first 2 rounds, experts were asked to score the severity of potential harm on a 5-point Likert-type scale. DDIs were directly included on the final list if the median score was 4 (major) or 5 (catastrophic). DDIs with a median score of 3 (moderate) were discussed at a consensus meeting and included if ≥75% of participants voted for inclusion in the final round. Consensus was achieved on 66 potentially clinically significant DDIs (28 had a median score of 4/5 and 48 of 3 in the Delphi survey). Most concerned cardiovascular, antithrombotic, and central nervous system drugs. The final list includes information on the mechanism of interaction, harm, and management. Treatment modification is recommended for three-quarters of DDIs. We validated a list of potentially clinically significant DDIs in older people, which can be used in clinical practice and education to support identification and management of DDIs or to assess prevalence in epidemiologic and intervention studies. [ABSTRACT FROM AUTHOR]