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Background: Alzheimer’s disease cerebrospinal fluid (CSF) biomarkers amyloid-β 1–42 (Aβ42), total tau (T-tau), and phosphorylated tau 181 (P-tau181) are widely used. However, concentration gradient of these biomarkers between intraventricular (V-CSF) and lumbar CSF (L-CSF) has been demonstrated in idiopathic normal pressure hydrocephalus (iNPH), potentially affecting clinical utility. Objective: Here we aim to provide conversion factors for clinical and research use between V-CSF and L-CSF. Methods: Altogether 138 iNPH patients participated. L-CSF samples were obtained prior to shunt surgery. Intraoperative V-CSF samples were obtained from 97 patients. Post-operative follow-up L- and V-CSF (shunt reservoir) samples of 41 patients were obtained 1–73 months after surgery and then after 3, 6, and 18 months. CSF concentrations of Aβ42, T-tau, and P-tau181 were analyzed using commercial ELISA assays. Results: Preoperative L-CSF Aβ42, T-tau, and P-tau181 correlated to intraoperative V-CSF (ρ= 0.34–0.55, p

When it comes to decision-making based on psychological and educational assessments, there is compelling evidence that statistical judgment is superior to holistic judgment. Yet, implementing this finding in practice has proven to be difficult for both academic and professional psychologists. Knowledge transfer from research findings to practitioners and other stakeholders in psychological assessment is a necessary condition to close this gap. To obtain insight into how academic specialists in psychological testing disseminate knowledge about research findings in this area, we investigated how textbooks on testing and guidelines on test use report on, or do not to report on, decision-making in psychological and educational assessment. Second, we discuss some commonly encountered misunderstandings, and third we argue for a broader and more in-depth dissemination of research findings on this topic in textbooks and test standards; to this end we provide some suggestions.

Current interrater reliability (IRR) coefficients ignore the nested structure of multilevel observational data, resulting in biased estimates of both subject- and cluster-level IRR. We used generalizability theory to provide a conceptualization and estimation method for IRR of continuous multilevel observational data. We explain how generalizability theory decomposes the variance of multilevel observational data into subject-, cluster-, and rater-related components, which can be estimated using Markov chain Monte Carlo (MCMC) estimation. We explain how IRR coefficients for each level can be derived from these variance components, and how they can be estimated as intraclass correlation coefficients (ICC). We assessed the quality of MCMC point and interval estimates with a simulation study, and showed that small numbers of raters were the main source of bias and inefficiency of the ICCs. In a follow-up simulation, we showed that a planned missing data design can diminish most estimation difficulties in these conditions, yielding a useful approach to estimating multilevel interrater reliability for most social and behavioral research. We illustrated the method using data on student-teacher relationships. All software code and data used for this article is available on the Open Science Framework: https://osf.io/bwk5t/. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

De afgelopen decennia is het risico op nieuwe of opnieuw opduikende infectieziekten toegenomen. In een niet-immune populatie kan dit voor grote medische, maatschappelijke en economische problemen zorgen. Driekwart van de nieuwe ziekteverwekkers komt van (wilde) dieren. Wanneer deze pathogenen vervolgens ook van mens tot mens overdraagbaar zijn, kan dit tot een pandemie leiden, zoals bij COVID-19 is gebeurd. Huisartsen kunnen als een van de eersten humane signalen van nieuwe infectieziekten oppikken. Daarmee spelen ze een belangrijke rol bij de vroegtijdige opsporing en bestrijding ervan.

Background Propylene chlorohydrins (PCH) are formed as byproducts in the reaction between starch and propylene oxide (PO). For hydroxypropylated starch (HP-starch) applications in food, JECFA set the maximum allowed total propylene chlorohydrin (PHC-t) residues level at 1 mg/kg. Objective To develop an improved analytical method for the determination of the PCH-t content in starches in the low mg/kg range to replace the outdated JECFA method. Method A new GC-MS method that utilizes aqueous methanol as extraction medium for PCH. The GC-MS system is equipped with a programmable temperature vaporization injector and Stabilwax-DA column using helium as carrier gas. The quantitative detection is achieved in the selected ion monitoring mode. Results This single laboratory validation (SLV) study showed good linear calibrations for both 1-chloro-2-propanol (PCH-1) and 2-chloro-1-propanol (PCH-2) in the concentration range of 0.5-4 mg/kg in dry starch. The lower limit of quantitation of PCH-1 and PCH-2 was 0.2–0.3 mg/kg in dry starch, the relative standard deviation reproducibility (RSDR) at the concentration level of 1–2 mg/kg in dry starch was 3–5%, and the recovery values for both PCH-1 and PCH-2 were in the range of 78–112% at a concentration level of about 0.6 mg/kg in dry starch. Compared with the current, outdated JECFA method, the new GC-MS method is more sustainable, less laborious and therefore more economical. The analytical capacity of the new method is 4–5 times higher than the analytical capacity of the old JECFA method. Conclusion The GC-MS method is fit for a Multi Laboratory Trial (MLT). Highlight Based on the results of this SLV and the MLT (will be published in a second paper), the Joint FAO/WHO Expert Committee on Food Additives has recently decided to replace the outdated GC-FID JECFA method for the new GC-MS method for the determination of PCH-t content in starches.

Purpose Mokken scale analysis (MSA) is an attractive scaling procedure for ordinal data. MSA is frequently used in health-related quality of life research. Two of MSA's prime features are the scalability coefficients and the automated item selection procedure (AISP). The AISP partitions a (large) set of items into scales based on the observed item scores; the resulting scales can be used as measurement instruments. There exist two issues in MSA: First, point estimates, standard errors, and test statistics for scalability coefficients are inappropriate for clustered item scores, which are omnipresent in quality of life research data. Second, the AISP insufficiently takes sampling fluctuation of Mokken’s scalability coefficients into account. Methods We solved both issues by providing point estimates and standard errors for the scalability coefficients for clustered data and by implementing a Wald-based significance test in the AISP algorithm, resulting in a test-guided AISP (T-AISP), that is available for both nonclustered and clustered test scores. Results We integrated the T-AISP into a two-step, test-guided MSA for scale construction, to guide the analysis for nonclustered and clustered data. The first step is performing a T-AISP and select the final scale( s ). For clustered data, within-group dependency is investigated on the final scale(s). In the second step, the strength of the scale(s) is determined and further analyses are performed. The procedure was demonstrated on clustered item scores obtained from administering a questionnaire on quality of life in schools to 639 students nested in 30 classrooms. Conclusions We developed a two-step, test-guided MSA for scale construction that takes into account sample fluctuation of all scalability coefficients and that can be applied to item scores obtained by a nonclustered or clustered sampling design.

Phase-variable Type I Restriction Modification (RM) systems are epigenetic regulatory systems that have been identified in numerous human bacterial pathogens. We previously showed that an emerging zoonotic lineage ofStreptococcus suisacquired a phase-variable Type I RM system named SsuCC20p. The SsuCC20p locus was present in the genome of disease-associated isolates from multiple streptococcal species. This indicates that it is not restricted toS. suisand can be acquired through horizontal gene transfer. We demonstrate that SsuCC20p phase-variability relies on a recombinase present within the locus.In vitro, only SsuCC20p is responsible for the genome methylation profiles that were detected in the representative zoonoticS. suisisolate 861160. In addition, we show that, contrary to previous observations,hsdSgenes located downstream of thehsdMgene and the recombinase gene, can contribute to the SsuCC20p genome methylation profile. SsuCC20p locked mutants expressing a singlehsdSeach showed unique genome methylation profiles. The differential genome methylation of the distinct locked mutants caused phase dependent differences in global gene expression in a growth condition dependent manner. We observed significant differences in virulence betweenhsdSlocked mutants in a zebrafish larvae infection model. These data indicate that the streptococcal phase-variable Type I RM system SsuCC20p can impact bacterial virulence via epigenetic regulation of gene expression and potentially contributes to the zoonotic potential ofS. suis.ImportancePhase-variation contributes to the virulence of bacterial pathogens as it allows a single strain to produce phenotypic diverse subpopulations. Phase-variable Restriction Modification (RM) systems are systems that allow for such phase-variation via epigenetic regulation of gene expression levels. The phase-variable RM system SsuCC20p was found in multiple streptococcal species and was acquired by an emerging zoonotic lineage ofStreptococcus suis. We show that the phase-variability of SsuCC20p is dependent on a recombinase encoded within the SsuCC20p locus. We characterized the genome methylation profiles of the different phases of SsuCC20p and showed that the differential genome methylation within the phases causes differences in gene expression levels and virulence. Altogether, we show that the acquisition of a phase-variable RM system impacts virulence and can potentially contribute to the zoonotic potential ofS. suis. Bacterial pathogens can increase their virulence through acquisition of mobile elements containing epigenetic regulatory systems such as RM systems.

Handleidingvan zelfrapportage-vragenlijst voor leerlingen in de leeftijd van 8 t/m 12 jaar waarmee het beeld van de relatie met een specifieke leerkracht in kaart wordt gebracht in termen van de relatiedimensies Nabijheid, Conflict en Negatieve Verwachtingen. Het acroniem SPARTS verwijst naar Student Perception of Affective Relationship with Teacher Scale. De handleiding bestaat uit de hoofdstukken: 1.Theoretische inleiding, 2. Testafname en gebruik, 3. Normatieve en descriptieve gegevens, .4 Betrouwbaarheid en stabiliteit, en 5. Begripsvaliditeit.

This book 'Essays on Contemporary Psychometrics' provides an overview of contemporary psychometrics, the science devoted to the advancement of quantitative measurement practices in psychology, education and the social sciences. The volume consists of four parts, each having several chapters on cutting-edge work in the field. Part I, General Perspectives on Psychometrics, includes expert views on topics such as psychological models vs. measurement models, using tests in decision making, artificial intelligence, and psychometric network models. Part II, Factor Analysis and Classical Test Theory, the type of psychometrics that is still used most often in the social and behavioral sciences, includes state-of-the-art contributions on test-score reliability, change-score reliability, handling missing data in principal component analysis, test equating, and conditional standard errors of measurement. Part III, Item Response Theory, the leading form of psychometrics in modern educational measurement, includes discussions of sampling from many conditional distributions, transparent score reporting, nonparametric item response theory, and targeted testing. Part IV, New Psychometrics, discusses recently developed ideas beyond classical test theory and item response theory, including topics related to computer adaptive testing, response-time modelling, validity indices, diagnostic classification models, and the sparse latent class model for ordinal measurements. Together, these four parts provide an overview of the current state-of-the-art in psychometrics in educational measurement. They are a valuable source of information for graduate students who (intend to) study psychometrics and need an overview of the field, and for researchers interested in the current developments in the field.

In education, testing procedures can be lengthy. The long duration takes up precious time and affects the quality of responses, possibly resulting in a biased diagnosis or wrong treatment. The problem can be reduced using computer adaptive testing (CAT). However, three issues prevent the use of traditional CAT: (1) the type of tests and questionnaires we focus on do not allow for the construction of large item banks, (2) the test data are usually not (approximately) unidimensional, and (3) the aim of the researchers may not only be measurement but also prediction. We propose a flexible generalization of CAT to accommodate these three issues, coined FlexCAT. First, FlexCAT estimates the (discrete) density of item-score vectors (denoted p) using any convenient model that provides a good description of p; this need not be an IRT model. Second, FlexCAT estimates test scores from $$ \hat{\mathbf{p}} $$ p ̂ . In contrast to traditional CAT, the test score need not be a latent trait but can also be the total score, ordinal scores such as percentiles, or external criteria that the test aims to predict. We introduce FlexCAT for the case that a latent class model is used to estimate p, and the total score is used as a test score. Using a real-data example, we compare the accuracy of FlexCAT and traditional CAT. Finally, we discuss the challenges FlexCAT still faces.

Streptococcus suis is an emerging zoonotic pathogen. Over 100 putative virulence factors have been described, but it is unclear to what extent these virulence factors could contribute to zoonotic potential of S. suis. We identified all S. suis virulence factors studied in experimental models of human origin in a systematic review and assessed their contribution to zoonotic potential in a subsequent genomic meta-analysis. PubMed and Scopus were searched for English-language articles that studied S. suis virulence published until 31 March 2021. Articles that analyzed a virulence factor by knockout mutation, purified protein, and/or recombinant protein in a model of human origin, were included. Data on virulence factor, strain characteristics, used human models and experimental outcomes were extracted. All publicly available S. suis genomes with available metadata on host, disease status and country of origin, were included in a genomic meta-analysis. We calculated the ratio of the prevalence of each virulence factor in human and pig isolates. We included 130 articles and 1703 S. suis genomes in the analysis. We identified 53 putative virulence factors that were encoded by genes which are part of the S. suis core genome and 26 factors that were at least twice as prevalent in human isolates as in pig isolates. Hhly3 and NisK/R were particularly enriched in human isolates, after stratification by genetic lineage and country of isolation. This systematic review and genomic meta-analysis have identified virulence factors that are likely to contribute to the zoonotic potential of S. suis.

R syntax to compute ICCs for (in)complete two-way designs using maximum likelihood estimation.

Background: Longitudinal changes in cerebrospinal fluid (CSF) biomarkers are seldom studied. Furthermore, data on biomarker gradient between lumbar (L-) and ventricular (V-) compartments seems to be discordant. Objective: To examine alteration of CSF biomarkers reflecting Alzheimer's disease (AD)-related amyloid-beta (A beta) aggregation, tau pathology, neurodegeneration, and early synaptic degeneration by CSF shunt surgery in idiopathic normal pressure hydrocephalus (iNPH) in relation to AD-related changes in brain biopsy. In addition, biomarker levels in L- and V-CSF were compared. Methods: L-CSF was collected prior to shunt placement and, together with V-CSF, 3-73 months after surgery. Thereafter, additional CSF sampling took place at 3, 6, and 18 months after the baseline sample from 26 iNPH patients with confirmed A beta plaques in frontal cortical brain biopsy and 13 iNPH patients without A beta pathology. CSF Amyloid-beta(42) (A beta(42)), total tau (T-tau), phosphorylated tau (P-tau(181)), neurofilament light (NFL), and neurogranin (NRGN) were analyzed with customized ELISAs. Results: All biomarkers but A beta(42) increased notably by 140-810% in L-CSF after CSF diversion and then stabilized. A beta(42) instead showed divergent longitudinal decrease between A beta-positive and -negative patients in L-CSF, and thereafter increase in A beta-negative iNPH patients in both L- and V-CSF. All five biomarkers correlated highly between V-CSF and L-CSF (A beta(42) R = 0.87, T-tau R = 0.83, P-tau R = 0.92, NFL R = 0.94, NRGN R = 0.9; all p < 0.0001) but were systematically lower in V-CSF (A beta(42) 14 %, T-tau 22%, P-tau 20%, NFL 32%, NRGN 19%). With APOE genotype-grouping, only A beta(42) showed higher concentration in non-carriers of allele epsilon 4. Conclusion: Longitudinal follow up shows that after an initial post-surgery increase, T-tau, P-tau, and NRGN are stable in iNPH patients regardless of brain biopsy A beta pathology, while NFL normalized toward its pre-shunt levels. A beta(42) as biomarker seems to be the least affected by the surgical procedure or shunt and may be the best predictor of AD risk in iNPH patients. All biomarker concentrations were lower in V-than L-CSF yet showing strong correlations.

For the construction of tests and questionnaires that require multiple raters (e.g., a child behaviour checklist completed by both parents) a novel ordinal scaling technique is currently being further developed, called two-level Mokken scale analysis. The technique uses within-rater and between-rater coefficients to assess the scalability of the test. These coefficients are generalizations of Mokken's scalability coefficients. In this paper we derived standard errors for the two-level coefficients and for their ratios. The coefficients, the estimates, the estimated standard errors and the software implementation are discussed and illustrated using a real-data example, and a small-scale simulation study demonstrates the accuracy of the estimates.

Interrater reliability (IRR) is often estimated by intraclass correlation coefficients (ICCs). Using Markov chain Monte Carlo (MCMC) estimation of Bayesian hierarchical models to estimate ICCs has several benefits over traditional approaches such as analysis of variance or maximum likelihood estimation. However, estimation of ICCs with small sample sizes and variance parameters close to zero, which are typical conditions in studies for which the IRR should be estimated, remains problematic in this MCMC approach. The estimation of the variance components that are used to estimate ICCs can heavily depend on the hyperprior distributions specified for these random-effect parameters. In this study, we explore the effect of a uniform and half-t hyperprior distribution on bias, coverage, and efficiency of the random-effect parameters and ICCs. The results indicated that a half-t distribution outperforms a uniform distribution but that slightly increasing the number of raters in a study is more influential than the choice of hyperprior distributions. We discuss implications and directions for future research.

Syntax and data belonging to chapter 5 of the dissertation 'Interrater Reliability for Incomplete and Dependent Data'

Syntax and data belonging to chapter 7 of the dissertation 'Interrater Reliability for Incomplete and Dependent Data'

Dieren kunnen ziekteverwekkers bij zich dragen waar mensen ook ziek van kunnen worden. De ziekten die hierdoor worden veroorzaakt, noemen we zoönosen. In 2021 onderzochten het RIVM, de NVWA en WFSR (Wageningen Food Safety Research) hoe vaak een aantal van deze ziekteverwekkers voorkwamen bij melkvee op 185 Nederlandse melkveebedrijven. Ook hebben 107 melkveehouders, gezinsleden en medewerkers aan dit onderzoek meegedaan om te kijken of zij deze ziekteverwekkers ook bij zich dragen. Bij de onderzochte koeien en kalveren komen een aantal ziekteverwekkers vaak voor. Ze zitten in de darmen van de dieren en dus ook in de mest. Melk kan tijdens het melken in aanraking komen met mest en op die manier besmet raken. Mensen kunnen de kans op een besmetting verkleinen door geen rauwe melk of rauwe melkproducten, zoals kaas, te consumeren. Het vlees kan tijdens de slacht besmet raken. Het is daarom belangrijk om rundvlees goed gaar te eten. Het RIVM heeft gekeken of dezelfde ziekteverwekkers in de ontlasting of in de neus van deze mensen voorkwamen. De meeste van deze ziekteverwekkers veroorzaken bij mensen diarree, maar soms kunnen infecties ernstiger verlopen. Daarnaast is er naar ESBL-producerende bacteriën en MRSA gekeken, omdat belangrijke groepen antibiotica daar niet tegen werken. Van de onderzochte ziekteverwekkers kwam Campylobacter het meest voor bij het melkvee: op 91 procent van de bedrijven. Bij de veehouders en gezinsleden werd Campylobacter bij 1 persoon gevonden. Het hoge percentage bij de dieren is dus niet direct terug te zien bij de veehouders. Daarnaast kwamen de Listeria en STEC-bacteriën regelmatig voor bij melkvee; namelijk op 34 procent (Listeria) en 21 procent (STEC) van de bedrijven. Twee deelnemers van de veehouders en gezinsleden droegen Listeria bij zich en één deelnemer STEC. ESBL-producerende bacteriën zijn op 8 procent van de bedrijven gevonden en bij 3 deelnemers. Het percentage bij de deelnemers is ongeveer hetzelfde als bij de Nederlandse bevolking. MRSA is op de huid van 4 procent van de koeien gevonden en bij één deelnemer. De bacterie Clostridioides is zowel bij koeien als bij kalveren onderzocht en kwam bij de kalveren jonger dan 4 weken vaker (18 procent) voor dan bij oudere dieren (4 procent). Dit was ook het geval bij de parasiet Cryptosporidium, die bij veel van de jonge kalveren voorkwam (72 procent). Zowel Clostridioides als Cryptosporidium zijn niet bij de deelnemers gevonden. Tenslotte werd op 4 bedrijven Salmonella gevonden. Salmonella werd niet bij de deelnemers aangetroffen.

We introduce the special section on nonparametric item response theory (IRT) in Quality of Life Research. Starting from the well-known Rasch model, we provide a brief overview of nonparametric IRT models and discuss the assumptions, the properties, and the investigation of goodness of fit. We provide references to more detailed texts to help readers getting acquainted with nonparametric IRT models. In addition, we show how the rather diverse papers in the special section fit into the nonparametric IRT framework. Finally, we illustrate the application of nonparametric IRT models using data from a questionnaire measuring activity limitations in walking. The real-data example shows the quality of the scale and its constituent items with respect to dimensionality, local independence, monotonicity, and invariant item ordering.

Streptococcus suis is an emerging zoonotic pathogen. Over 100 putative virulence factors have been described, but it is unclear to what extent these virulence factors could contribute to zoonotic potential of S. suis. We identified all S. suis virulence factors studied in experimental models of human origin in a systematic review and assessed their contribution to zoonotic potential in a subsequent genomic meta-analysis. PubMed and Scopus were searched for English-language articles that studied S. suis virulence published until 31 March 2021. Articles that analyzed a virulence factor by knockout mutation, purified protein, and/or recombinant protein in a model of human origin, were included. Data on virulence factor, strain characteristics, used human models and experimental outcomes were extracted. All publicly available S. suis genomes with available metadata on host, disease status and country of origin, were included in a genomic meta-analysis. We calculated the ratio of the prevalence of each virulence factor in human and pig isolates. We included 130 articles and 1703 S. suis genomes in the analysis. We identified 53 putative virulence factors that were encoded by genes which are part of the S. suis core genome and 26 factors that were at least twice as prevalent in human isolates as in pig isolates. Hhly3 and NisK/R were particularly enriched in human isolates, after stratification by genetic lineage and country of isolation. This systematic review and genomic meta-analysis have identified virulence factors that are likely to contribute to the zoonotic potential of S. suis.

The lack of ideal measurement of treatment efficacy is a well acknowledged problem in the epilepsy community, both in clinical care and clinical trials. Whilst still the current gold-standard, self-reported seizure frequency significantly underestimates the true number of seizures and does not account for any other at least equally important outcome parameters, such as neurodevelopment and cognition. With the rise of disease modifying treatments, the need for more reliable endpoints in practice and clinical trials becomes more pressing. In this paper we assembled an expert panel to discuss the nature of these needs, current limitations, and obstacles based on a survey amongst these experts who were queried about the most important issues regarding the use of electroencephalography (EEG) parameters as endpoints in clinical drug and device development.A structured survey was sent to a group of experts in the design and conduct of epilepsy trials in adults and children. This was followed by a virtual in-person meeting discussing the results of the trial and identifying a list of most important issues.Six clinical trialists and 5 individuals from pharmaceutical companies returned the survey containing 14 questions, and 8 clinical trialists and 10 pharma-representatives attended the meeting. Three main issues were identified (1) lack of accuracy of seizure diaries due to nocturnal seizures, subtle motor seizures, impairment of consciousness and lack of awareness of the seizure by the patient (2) inter-rater variability of EEG assessment (3) lack of standardization regarding definition(s) of seizures (clinical and electrographic), EEG recording methods and EEG data management. Recommended solutions included (1) validation of EEG parameters as biomarkers and use of wearables (2) development of a manual that describes EEG rating criteria, protocol for validation by 1 central reader and use of a resolution of disagreements reporting template (3) standardization of EEG recording, data management and reporting.Current developments in research and technology seem promising to advance the use of EEG parameters as potential endpoints and offer partial solutions to the current needs. However, continuous, focused and collaborative efforts of all stakeholders (academia, industry and regulatory agencies) are needed to formulate guidelines, validate emerging technologies and approve them for use in trials. It is the intent of this opinion "position paper" to stimulate those efforts.

Respiratory infections caused by Bordetella pertussis are reemerging despite high pertussis vaccination coverage. Since the introduction of the acellular pertussis vaccine in the late twentieth century, circulating B. pertussis strains increasingly lack expression of the vaccine component pertactin (Prn). In some countries, up to 90% of the circulating B. pertussis strains are deficient in Prn. To better understand the resurgence of pertussis, we investigated the response of human monocyte-derived dendritic cells (moDCs) to naturally circulating Prn-expressing (Prn-Pos) and Prn-deficient (Prn-Neg) B. pertussis strains from 2016 in the Netherlands. Transcriptome analysis of moDC showed enriched IFNα response-associated gene expression after exposure to Prn-Pos B. pertussis strains, whereas the Prn-Neg strains induced enriched expression of interleukin- and TNF-signaling genes, as well as other genes involved in immune activation. Multiplex immune assays confirmed enhanced proinflammatory cytokine secretion by Prn-Neg stimulated moDC. Comparison of the proteomes from the Prn-Pos and Prn-Neg strains revealed, next to the difference in Prn, differential expression of a number of other proteins including several proteins involved in metabolic processes. Our findings indicate that Prn-deficient B. pertussis strains induce a distinct and stronger immune activation of moDCs than the Prn-Pos strains. These findings highlight the role of pathogen adaptation in the resurgence of pertussis as well as the effects that vaccine pressure can have on a bacterial population.

IntroductionLoss of sensation due to diabetes‐related neuropathy often leads to diabetic foot ulceration. Several test instruments are used to assess sensation, such as static and moving 2‐point discrimination (S2PD, M2PD), monofilaments, and tuning forks.MethodsMokken scale analysis was applied to the Rotterdam Diabetic Foot Study data to select hierarchies of tests to construct measurement scales.ResultsWe developed 39‐item and 31‐item scales to measure loss of sensation for research purposes and a 13‐item scale for clinical practice. All instruments were strongly scalable and reliable. The 39 items can be classified into 5 hierarchically ordered core clusters: S2PD, M2PD, vibration sense, monofilaments, and prior ulcer or amputation.DiscussionGuided by the presented scales, clinicians may better classify the grade of sensory loss in diabetic patients’ feet. Thus, a more personalized approach concerning individual recommendations, intervention strategies, and patient information may be applied.

Two-level Mokken scale analysis is a generalization of Mokken scale analysis for multi-rater data. The bias of estimated scalability coefficients for two-level Mokken scale analysis, the bias of their estimated standard errors, and the coverage of the confidence intervals has been investigated, under various testing conditions. It was found that the estimated scalability coefficients were unbiased in all tested conditions. For estimating standard errors, the delta method and the cluster bootstrap were compared. The cluster bootstrap structurally underestimated the standard errors of the scalability coefficients, with low coverage values. Except for unequal numbers of raters across subjects and small sets of items, the delta method standard error estimates had negligible bias and good coverage. Post hoc simulations showed that the cluster bootstrap does not correctly reproduce the sampling distribution of the scalability coefficients, and an adapted procedure was suggested. In addition, the delta method standard errors can be slightly improved if the harmonic mean is used for unequal numbers of raters per subject rather than the arithmetic mean.

Background In the Netherlands, healthcare professionals attending patients in the last phase of life, can consult an expert palliative care team (PCT) in case of complex problems. There are two types of PCTs: regional PCTs, which are mainly consulted by general practitioners, and hospital PCTs, which are mainly consulted by healthcare professionals in the hospital. Integration of these PCTs is expected to facilitate continuity of care for patients receiving care in different settings. We studied facilitators and barriers in the process of developing and implementing an integrated transmural palliative care consultation service. Methods A multiple case study was performed in four palliative care networks in the southwest Netherlands. We aimed to develop an integrated transmural palliative care consultation service. Researchers were closely observing the process and participated in project team meetings. A within-case analysis was conducted for each network, using the Consolidated Framework for Implementation Research (CFIR). Subsequently, all findings were pooled. Results In each network, project team members thought that the core goal of a transmural consultation service is improvement of continuity of palliative care for patients throughout their illness trajectory. It was nevertheless a challenge for hospital and non-hospital healthcare professionals to arrive at a shared view on goals, activities and working procedures of the transmural consultation service. All project teams experienced the lack of evidence-based guidance on how to organise the service as a barrier. The role of the management of the involved care organisations was sometimes perceived as unsupportive, and different financial reimbursement systems for hospital and out-of-hospital care made implementation of a transmural consultation service complex. Three networks managed to develop and implement a transmural service at some level, one network did not manage to do so. Conclusions Healthcare professionals are motivated to collaborate in a transmural palliative care consultation service, because they believe it can contribute to high-quality palliative care. However, they need more shared views on goals and activities of a transmural consultation service, more guidance on organisational issues and appropriate financing. Further research is needed to provide evidence on benefits and costs of different models of integrated transmural palliative care consultation services.

JNJ-42165279 is a selective inhibitor of fatty acid amide hydrolase (FAAH), the enzyme responsible for the degradation of fatty acid amides (FAA) including anandamide (AEA), palmitoylethanolamide (PEA), and N-oleoylethanolamide (OEA). We assessed the efficacy, safety, tolerability, pharmacokinetics, and pharmacodynamics of treatment with JNJ-42165279 in subjects with social anxiety disorder (SAD). This was a multicenter, double-blind, placebo-controlled study randomizing subjects to 12 weeks of treatment with either JNJ-42165279 (25 mg daily) or placebo (PBO). The primary endpoint was the change in the Liebowitz Social Anxiety Scale (LSAS) total score from baseline to end of study. Secondary endpoints included the Hamilton Anxiety Scale (HAM-A), Hamilton Depression Rating Scale (HDRS17), and the Clinical Global Impression-Improvement (CGI-I). Samples were collected for plasma concentration of AEA, PEA, OEA, and JNJ-42165279. A total of 149 subjects were enrolled with a mean baseline LSAS total score of 102.6 (SD 16.84). The mean change from baseline (SD) in LSAS total score at week 12 was numerically greater for JNJ-42165279: -29.4 (27.47) compared to PBO: -22.4 (23.57) but not significant. The percentage of subjects with ≥30% improvement from baseline in the LSAS total score was significantly higher for JNJ-42165279 (42.4%) compared to PBO (23.6%) (p value = 0.04). The percentage of subjects with a CGI-I score of much or very much improved was also significantly higher for JNJ-42165279 (44.1%) than for PBO (23.6%) (p value = 0.02). The drug was well tolerated. JNJ-42165279 appears to elicit an anxiolytic effect in subjects with SAD although trough concentrations with 25 mg once daily appeared to be insufficient to completely inhibit FAAH activity which may have led to suboptimal efficacy. ClinicalTrials.gov Identifier: NCT02432703.

Background One of the strategies to promote the quality of palliative care in non-specialised settings is the appointment of palliative care nurse champions. It is unclear what the most effective model to implement the concept of nurse champions is and little is known about palliative care nurse champions’ own views on their role and responsibilities. This paper aims to describe views of palliative care nurse champions in hospitals and home care on their role, responsibilities and added value. Methods In 2018, a qualitative interview study was conducted with 16 palliative care nurse champions in two hospitals and four home care organisations in the southwest of the Netherlands. The framework approach was used to analyse the data. Results Most palliative care nurse champions described their role by explaining concrete tasks or activities. Most nurse champions perceive their main task as disseminating information about palliative care to colleagues. A few nurses mentioned activities aimed at raising awareness of palliative care among colleagues. Most nurses were to a limited extent involved in collaboration with the palliative care expert team. Hospital nurse champions suggested that more support from the palliative care expert team would be helpful. Most nurse champions feel little responsibility for organisational tasks and inter-organisational collaboration. Especially hospital nurses found it difficult to describe their role. Conclusion The role of palliative care nurse champions in hospital and home care varies a lot and nurses have diverging views on palliative care in these settings. Comprehensively fulfilling the role of palliative care nurse champion is a challenge. Careful selection, training, support and task descriptions for nurse champions are needed to make the concept of nurse champions work in palliative care.

Mokken’s scalability coefficients take values on the interval (−∞, 1]. The sampling distribution of scalability coefficients is skewed near the boundary, so Wald-based confidence intervals and significance tests may be biased. We introduce a transformation of the scalability coefficients and their standard errors, which can be used to construct range-preserving confidence intervals and significance tests. We demonstrated that for scalability coefficients away from the boundary, the properties of this range-preserving method are similar to the properties of the Wald-based method, but the range-preserving method outperforms the Wald-based method when the coefficient is close to unity. The range-preserving method can be applied to all types of scalability coefficients. Its implementation in software is discussed.

Despite the overwhelming use of tests and questionnaires, the psychometric models for constructing these instruments are often poorly understood, leading to suboptimal measurement. Measurement Models for Psychological Attributes is a comprehensive and accessible treatment of the common and the less than common measurement models for the social, behavioral, and health sciences. The monograph explains the adequate use of measurement models for test construction, points out their merits and drawbacks, and critically discusses topics that have raised and continue to raise controversy. Because introductory texts on statistics and psychometrics are sufficient to understand its content, the monograph may be used in advanced courses on applied psychometrics and is attractive to both researchers and graduate students in psychology, education, sociology, political science, medicine and marketing, policy research, and opinion research.

Respiratory infections caused by Bordetella pertussis are reemerging despite high pertussis vaccination coverage. Since the introduction of the acellular pertussis vaccine in the late twentieth century, circulating B. pertussis strains increasingly lack expression of the vaccine component pertactin (Prn). In some countries, up to 90% of the circulating B. pertussis strains are deficient in Prn. To better understand the resurgence of pertussis, we investigated the response of human monocyte-derived dendritic cells (moDCs) to naturally circulating Prn-expressing (Prn-Pos) and Prn-deficient (Prn-Neg) B. pertussis strains from 2016 in the Netherlands. Transcriptome analysis of moDC showed enriched IFNα response-associated gene expression after exposure to Prn-Pos B. pertussis strains, whereas the Prn-Neg strains induced enriched expression of interleukin- and TNF-signaling genes, as well as other genes involved in immune activation. Multiplex immune assays confirmed enhanced proinflammatory cytokine secretion by Prn-Neg stimulated moDC. Comparison of the proteomes from the Prn-Pos and Prn-Neg strains revealed, next to the difference in Prn, differential expression of a number of other proteins including several proteins involved in metabolic processes. Our findings indicate that Prn-deficient B. pertussis strains induce a distinct and stronger immune activation of moDCs than the Prn-Pos strains. These findings highlight the role of pathogen adaptation in the resurgence of pertussis as well as the effects that vaccine pressure can have on a bacterial population.

JNJ-42165279 is a selective inhibitor of fatty acid amide hydrolase (FAAH), the enzyme responsible for the degradation of fatty acid amides (FAA) including anandamide (AEA), palmitoylethanolamide (PEA), and N-oleoylethanolamide (OEA). We assessed the efficacy, safety, tolerability, pharmacokinetics, and pharmacodynamics of treatment with JNJ-42165279 in subjects with social anxiety disorder (SAD). This was a multicenter, double-blind, placebo-controlled study randomizing subjects to 12 weeks of treatment with either JNJ-42165279 (25 mg daily) or placebo (PBO). The primary endpoint was the change in the Liebowitz Social Anxiety Scale (LSAS) total score from baseline to end of study. Secondary endpoints included the Hamilton Anxiety Scale (HAM-A), Hamilton Depression Rating Scale (HDRS17), and the Clinical Global Impression-Improvement (CGI-I). Samples were collected for plasma concentration of AEA, PEA, OEA, and JNJ-42165279. A total of 149 subjects were enrolled with a mean baseline LSAS total score of 102.6 (SD 16.84). The mean change from baseline (SD) in LSAS total score at week 12 was numerically greater for JNJ-42165279: −29.4 (27.47) compared to PBO: −22.4 (23.57) but not significant. The percentage of subjects with ≥30% improvement from baseline in the LSAS total score was significantly higher for JNJ-42165279 (42.4%) compared to PBO (23.6%) (p value = 0.04). The percentage of subjects with a CGI-I score of much or very much improved was also significantly higher for JNJ-42165279 (44.1%) than for PBO (23.6%) (p value = 0.02). The drug was well tolerated. JNJ-42165279 appears to elicit an anxiolytic effect in subjects with SAD although trough concentrations with 25 mg once daily appeared to be insufficient to completely inhibit FAAH activity which may have led to suboptimal efficacy. ClinicalTrials.gov Identifier: NCT02432703.

Attachment insecurity and difficulty with mentalization are common in patients with eating disorders and might be related to their symptoms and lack of autonomy.br/AIM: To investigate the role of attachment and mentalization in the course of anorexia nervosa (AN) and bulimia nervosa (BN).br/METHOD: Patients with AN and BN were assessed at the start of treatment, and after 1 year and 1.5 years concerning attachment security and mentalization in relation to eating disorder and co-morbid symptoms and autonomy. The results at the start of treatment were compared to those of controls without an eating disorder.br/RESULTS: Attachment insecurity and low level of mentalization were more prevalent in patients than in controls, and associated with borderline personality disorder and/or self-injurious behaviour. Attachment security increased after 1 year of treatment. Recovery from eating disorder after 1 year was related to higher level of mentalization and improvement of autonomy. Low pre-treatment level of mentalization predicted persistence of eating disorder until 1.5 years of follow-up.br/CONCLUSION: Good mentalization is associated with recovery from eating disorder. More research on the effect of mentalization based treatment for patients with eating disorders, with or without borderline personality disorder, is recommended.

The zoonotic pathogen Streptococcus suis can cause septicemia and meningitis in humans. We report five complete genomes of Streptococcus suis serotype 2 and serotype 9, covering the complete phylogeny of serotype 9 Dutch porcine isolates and zoonotic isolates. The isolates include the model strain S10 and the Dutch emerging zoonotic lineage.

ACHTERGROND Onveilige gehechtheid en moeite met mentaliseren komen vaak voor bij patiënten met een eetstoornis, en hangen mogelijk samen met hun symptomen en gebrek aan autonomie. DOEL Zicht krijgen op de rol van gehechtheid en mentaliseren in het beloop van anorexia (AN) en bulimia nervosa (BN). METHODE Patiënten met AN en BN werden bij de start van behandeling, 1 jaar later en 1,5 jaar later, onderzocht op gehechtheid en mentaliserend vermogen in relatie tot eetstoornissymptomen, comorbiditeit en autonomie. De metingen bij de start werden vergeleken met die van personen zonder eetstoornis. RESULTATEN Onveilige gehechtheid en een laag mentaliserend vermogen kwamen meer voor bij patiënten dan bij controlepersonen, en hingen samen met een borderlinepersoonlijkheidsstoornis en/of zelfverwondend gedrag. Veilige gehechtheid nam toe in 1 jaar van behandeling. Herstel van de eetstoornis na 1 jaar ging gepaard met een hoger mentaliserend vermogen en toegenomen autonomie. Een laag mentaliserend vermogen bij aanvang van de behandeling bleek het voortduren van de eetstoornis 1,5 jaar later te voorspellen. CONCLUSIE Goed mentaliseren hangt samen met verbetering van een eetstoornis. Onderzoek naar het effect van mentalization-based treatment bij patiënten met een eetstoornis, met of zonder comorbide borderlinepersoonlijkheidsstoornis, wordt aanbevolen.

When we call a person reliable, we mean that one can trust her to do what she promised to do. In other words, a reliable person shows behavior one expects. Technical devices typically are classified as reliable or unreliable. As cars grow older, technical malfunctioning becomes more likely, and they gradually become unreliable, meaning they no longer can be expected to take you from A to B without problems. Technical definitions of reliability also have entered the nonscientific arena. The Merriam-Webster dictionary defines reliability as “the extent to which an experiment, test, or measuring procedure yields the same results on repeated trials” (retrieved from http://www.merriam-webster.com/dictionary/reliability). This definition emphasizes repeatability of results when one collects new data under the same conditions as data were collected previously, and it comes close to what psychometric reliability is. The Oxford...

Background When patients receiving palliative care are transferred between care settings, adequate collaboration and information exchange between health care professionals is necessary to ensure continuity, efficiency and safety of care. Several studies identified deficits in communication and information exchange between care settings. Aim of this study was to get insight in the quality of collaboration and information exchange in palliative care from the perspectives of nurses. Methods We performed a cross-sectional regional survey study among nurses working in different care settings. Nurses were approached via professional networks and media. Respondents were asked questions about collaboration in palliative care in general and about their last deceased patient. Potential associations between quality scores for collaboration and information handovers and characteristics of respondents or patients were tested with Pearson’s chi-square test. Results A total of 933 nurses filled in the questionnaire. Nurses working in nursing homes were least positive about inter-organizational collaboration. Forty-six per cent of all nurses had actively searched for such collaboration in the last year. For their last deceased patient, 10% of all nurses had not received the information handover in time, 33% missed information they needed. An adequate information handover was positively associated with timeliness and completeness of the information and the patient being well-informed, not with procedural characteristics. Conclusion Nurses report that collaboration between care settings and information exchange in palliative care is suboptimal. This study suggests that health care organizations should give more attention to shared professionalization towards inter-organizational collaboration among nurses in order to facilitate high-quality palliative care.

Respondents may use satisficing (i.e., nonoptimal) strategies when responding to self-report questionnaires. These satisficing strategies become more likely with decreasing motivation and/or cognitive ability (Krosnick, 1991). Considering that cognitive deficits are characteristic of depressive and anxiety disorders, depressed and anxious patients may be prone to satisficing. Using data from the Netherland’s Study of Depression and Anxiety ( N = 2,945), we studied the relationship between depression and anxiety, cognitive symptoms, and satisficing strategies on the NEO Five-Factor Inventory. Results showed that respondents with either an anxiety disorder or a comorbid anxiety and depression disorder used satisficing strategies substantially more often than healthy respondents. Cognitive symptom severity partly mediated the effect of anxiety disorder and comorbid anxiety disorder on satisficing. The results suggest that depressed and anxious patients produce relatively low-quality self-report data—partly due to cognitive symptoms. Future research should investigate the degree of satisficing across different mental health care assessment contexts.