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Summary: Background and Aims: Poor body composition is associated with impaired outcomes in patients with chronic liver disease (CLD), and various assessment tools are used. The aim of this study is to gain insight into the clinical practice of nutritional assessment in patients with CLD. Methods: A semi-structured online survey on nutritional assessment tools for measuring body composition in patients with CLD was conducted among hepatologists and dietitians, mainly from hospitals between April 2023 and May 2023. Results: A total of 45 eligible surveys were included in this study (dieticians N=35, hepatologists N=10). All dieticians had at least one nutritional assessment tool available. Bio-electrical impedance and hand-grip strength were the most available and used. The most important reasons for assessment were diagnosis of nutritional status, evaluation of nutritional intervention and for assessing risk of mortality. A proportion of 49% of the dieticians and 60% of the hepatologists respectively were familiar with the ‘European society of parenteral and enteral nutrition Guideline Clinical Nutrition in Liver disease’. Only 13% of dieticians and 60% of the hepatologists knew the ‘European Association for the Study of the Liver Clinical Practice Guidelines on nutrition in chronic liver disease’ and only eight dieticians and one hepatologist used a protocol for nutritional assessment in patients with CLD. Conclusion: The importance of measuring body composition in patients with CLD for diagnosing and monitoring nutritional status and for assessing risk of mortality is well-known by dieticians and most hepatologists. However, implementation of the current guidelines is substandard and should be improved.

Objectives: Studies have shown temporal changes in post-acute sequelae of COVID-19 (PASC) prevalence for early SARS-CoV-2 variants, although often lacking controls. This prospective study assesses the prevalence of symptoms in Delta- and Omicron-infected cases up to 12 months compared with population controls. Methods: Adult participants filled out surveys every 3 months (T0-T12) between July 2021 and August 2023. Cases were recruited with a positive SARS-CoV-2 test during the Delta or Omicron domination. Population controls were randomly invited from the Dutch Personal Records Database. Participants indicated the presence of 13 PASC-associated symptoms, and severity scores of fatigue, cognitive impairment, dyspnea, and pain. PASC prevalence was defined as the excess prevalence of havingat least one PASC-associated symptom in cases compared with population controls. Results: PASC prevalence was 34.3% at T3 and decreased to 21.7% at T12 for Delta and decreased from 18.7% at T3 to 16.7% at T12 for Omicron. At T12, the difference between Delta and Omicron was not significant. Delta cases generally had higher excess symptom scores for fatigue, dyspnea, and cognitive impairment than Omicron. Conclusions: In the first 9 months after infection, PASC prevalence was higher for Delta than Omicron, but the difference reduced over time and approximated after 12 months.

Symptom-only case definitions are insufficient to discriminate COVID-like illness from acute respiratory infection (ARI) or influenza-like illness (ILI), due to the overlap in case definitions. Our objective was to develop a statistical method that does not rely on case definitions to determine the contribution of influenza virus and SARS-CoV-2 to the ARI burden during periods when both viruses are circulating. Data sources used for testing the approach were weekly ARI syndrome reports from the Infectieradar participatory syndromic surveillance system during the analysis period (the first 25 weeks of 2022, in which SARS-CoV-2 and influenza virus co-circulated in the Netherlands) and data from virologically tested ARI (including ILI) patients who consulted a general practitioner in the same period. Estimation of the proportions of ARI attributable to influenza virus, SARS-CoV-2, or another cause was framed as an inference problem, through which all data sources are combined within a Bayesian framework to infer the weekly numbers of ARI reports attributable to each cause. Posterior distributions for the attribution proportions were obtained using Markov Chain Monte-Carlo methods. Application of the approach to the example data sources indicated that, of the total ARI reports (total of 11,312; weekly mean of 452) during the analysis period, the model attributed 35.4% (95% CrI: 29.2-40.0%) and 27.0% (95% CrI: 19.3-35.2%) to influenza virus and SARS-CoV-2, respectively. The proposed statistical model allows the attribution of respiratory syndrome reports from participatory surveillance to either influenza virus or SARS-CoV-2 infection in periods when both viruses are circulating, but comparability of the participatory surveillance and virologically tested populations is important. Portability for use by other countries with established participatory respiratory surveillance systems is an asset.

Background Measles outbreaks are still routine, even in countries where vaccination coverage exceeds the guideline of 95%. Therefore, achieving ambitions for measles eradication will require understanding of how unvaccinated children interact with others who are unvaccinated. It is well established that schools and homes are key settings for both clustering of unvaccinated children and for transmission of infection. In this study, we evaluate the potential for contacts between unvaccinated children in these contexts to facilitate measles outbreaks with a focus on the Netherlands, where large outbreaks have been observed periodically since the introduction of mumps, measles and rubella (MMR). Methods and findings We created a network of all primary and secondary schools in the Netherlands based on the total number of household pairs between each school. A household pair are siblings from the same household who attend a different school. We parameterised the network with individual level administrative school and household data provided by the Dutch Ministry for Education and estimates of school level uptake of the MMR vaccine. We analysed the network to establish the relative strength of contact between schools and found that schools associated with low vaccine uptake are highly connected, aided by a differentiated school system in the Netherlands (Coleman homophily index (CHI) = 0.63). We simulated measles outbreaks on the network and evaluated the model against empirical measles data per postcode area from a large outbreak in 2013 (2,766 cases). We found that the network-based model could reproduce the observed size and spatial distribution of the historic outbreak much more clearly than the alternative models, with a case weighted receiver operating characteristic (ROC) sensitivity of 0.94, compared to 0.17 and 0.26 for models that do not account for specific network structure or school-level vaccine uptake, respectively. The key limitation of our framework is that it neglects transmission routes outside of school and household contexts. Conclusions Our framework indicates that clustering of unvaccinated children in primary schools connected by unvaccinated children in related secondary schools lead to large, connected clusters of unvaccinated children. Using our approach, we could explain historical outbreaks on a spatial level. Our framework could be further developed to aid future outbreak response., Author(s): James D. Munday 1,2,3,*, Katherine E. Atkins 1,2,4, Don Klinkenberg 5, Marc Meurs 6, Erik Fleur 6, Susan JM Hahné 5, Jacco Wallinga 5,7, Albert Jan van Hoek 1,2,5 [...]

Background & Aims: Although primary biliary cholangitis (PBC) is considered a rare disorder, accurate determination of its incidence and prevalence remains challenging due to limited comprehensive population-based registries. We aimed to assess the incidence and prevalence of PBC in the Netherlands over time through the nationwide Dutch PBC Cohort Study (DPCS). Methods: DPCS retrospectively included every identifiable patient with PBC in the Netherlands from 1990 onwards in all 71 Dutch hospitals. Incidence and prevalence were assessed between 2008-2018 by Poisson regression between sex and age groups over time. Results: On the 1st of January 2008, there were 1,458 patients with PBC in the Netherlands. Between 2008-2018, 2,187 individuals were newly diagnosed, 46 were transplanted and 468 died. The yearly incidence of PBC in 2008 was 1.38, increasing to 1.74 per 100,000 persons in 2018. When compared to those aged

Introduction The social determinants of health contribute to poorer health outcomes for children with cerebral palsy (CP) and are barriers to families accessing health services. At an individual level, social determinants of health are experienced as unmet social needs, for example, unsafe housing conditions. There is emerging evidence that clinical pathways for the systematic identification and referral to services for unmet social needs can support families to address these needs. These clinical pathways have not been implemented for children with CP. The objectives are to investigate the feasibility and acceptability of two co-designed social needs clinical pathways for parents/caregivers of children with CP—social prescribing (ie, Community Linker plus resource pack) compared with resource pack only.Methods and analysis This pilot randomised controlled trial will run at the three tertiary paediatric rehabilitation services in New South Wales, Australia. A total of 120 participants will be recruited, with randomisation stratified by study site. A survey tool will be used to identify families experiencing unmet social needs. Parents/caregivers who report one or more unmet social need/s and consent will be eligible. The active control group will receive a resource pack containing information on community services to support unmet social needs. The social prescribing intervention group will receive one-on-one Community Linker support, in addition to the resource pack. The survey tool, intervention, logic model, and resource pack were co-designed with patient families and their healthcare workers. Feasibility of the research design and the clinical pathways will be evaluated using the number/proportion of parents/caregivers who complete the survey tool, consent, engage with the intervention, and complete research measures. Acceptability will be evaluated using questionnaires and qualitative interviews.Ethics and dissemination Human research ethics approval was granted by the Sydney Children’s Hospitals Network Human Research Ethics Committee (2022/ETH01688). Participants and stakeholders will receive updates and findings via regular communication channels including meetings, presentations, and publications.Trial registration number Australia New Zealand Clinical Trials Registry: 12622001459718.

With >7000 species the order of rust fungi has a disproportionately large impact on agriculture, horticulture, forestry and foreign ecosystems. The infectious spores are typically dikaryotic, a feature unique to fungi in which two haploid nuclei reside in the same cell. A key example is Phakopsora pachyrhizi, the causal agent of Asian soybean rust disease, one of the world's most economically damaging agricultural diseases. Despite P. pachyrhizi's impact, the exceptional size and complexity of its genome prevented generation of an accurate genome assembly. Here, we sequence three independent P. pachyrhizi genomes and uncover a genome up to 1.25 Gb comprising two haplotypes with a transposable element (TE) content of ~93%. We study the incursion and dominant impact of these TEs on the genome and show how they have a key impact on various processes such as host range adaptation, stress responses and genetic plasticity.

Two distinct stx2f-carrying Escherichia coli (E. coli) strains, isolated from a child with uncomplicated diarrhea fifteen weeks apart, were characterized by combining short- and long-read sequencing to compare their genetic relatedness. One strain was characterized as Shiga toxin-producing E. coli (STEC)/typical enteropathogenic E. coli (tEPEC) O63:H6 with a repertoire of virulence genes including stx2f, eae (α2-subtype), cdt, and bfpA. The other STEC with serotype O157:H16, reported for the first time as stx2f-carrying Escherichia coli in this study, possessed, in addition, eae (ε-subtype) and cdt, amongst other virulence-related genes. BLAST comparison showed that the stx2f-harboring prophage sequences of both strains were highly homologous (99.6% identity and 96.1% coverage). These results were corroborated by core Stx2f phage Multilocus Sequence Typing (cpMLST) as the stx2f-harboring prophages of both isolates clustered together when compared to those of 167 other human stx2f-carrying Escherichia coli. Overall, the stx2f-harboring prophages of the two distinct E. coli strains isolated from the present case were highly similar, suggesting that the stx2f-harboring phage might have been transferred from the STEC/tEPEC O63:H6 strain to the atypical EPEC (aEPEC) O157:H16 strain in the gut of the child.

This article describes the qualitative study of the redesigning of a course based on the Canadian "4CO-teaching method" for student teachers. This method consists of four different phases of co-teaching: co-design, co-execution, co-debriefing, and coreflection. Through this way of co-teaching, student teachers in both primary education and in arts education (theatre, dance, and visual arts) were taught how to design arts lessons for primary education together, how to carry them out as a couple, and how to jointly reflect on their lessons. The course, called "Teamplayers", aimed to teach these student teachers how to complement their knowledge and skills during the designing and teaching of arts lessons and, thus, enhance the quality of arts education. This research study evaluated the design of Teamplayers and the students' experience with the method of 4CO-teaching with the aim of improving the course. [Note: The title on the PDF has "CO4" instead of "4CO" as found throughout the paper.]