Mind the gap: knowledge, attitudes and perceptions on antimicrobial resistance, antimicrobial stewardship and infection prevention and control in long-term care facilities for people with disabilities in the Netherlands.

BACKGROUND: Antimicrobial resistance (AMR) has become one of the major public health threats worldwide, emphasizing the necessity of preventing the development and transmission of drug resistant microorganisms. This is particularly important for people with vulnerable health conditions, such as people with intellectual disabilities (ID) and long-term care residents. This study aimed to assess the current status of AMR, antimicrobial stewardship (AMS) and infection prevention and control (IPC) in Dutch long-term care facilities for people with intellectual disabilities (ID-LTCFs). METHODS: A web-based cross-sectional survey distributed between July and November 2023, targeting (both nonmedically and medically trained) healthcare professionals working in ID-LTCFs in The Netherlands, to study knowledge, attitudes and perceptions regarding AMR, AMS and IPC. RESULTS: In total, 109 participants working in 37 long-term care organizations for people with intellectual disabilities throughout the Netherlands completed the questionnaire. The knowledge levels of AMR and IPC among nonmedically trained professionals (e.g., social care professionals) were lower than those among medically trained professionals (p = 0.026). In particular regarding the perceived protective value of glove use, insufficient knowledge levels were found. Furthermore, there was a lack of easy-read resources and useful information regarding IPC and AMR, for both healthcare professionals as well as people with disabilities. The majority of the participants (> 90%) reported that AMR and IPC need more attention within the disability care sector, but paradoxically, only 38.5% mentioned that they would like to receive additional information and training about IPC, and 72.5% would like to receive additional information and training about AMR. CONCLUSION: Although the importance of AMR and IPC is acknowledged by professionals working in ID-LTCFs, there is room for improvement in regards to appropriate glove use and setting-specific IPC and hygiene policies. As nonmedically trained professionals comprise most of the workforce within ID-LTCFs, it is also important to evaluate their needs. This can have a substantial impact on developing and implementing AMR, AMS and/or IPC guidelines and policies in ID-LTCFs.

Water Sensitive Cities Index: A diagnostic tool to assess water sensitivity and guide management actions.

Cities are wrestling with the practical challenges of transitioning urban water services to become water sensitive; capable of enhancing liveability, sustainability, resilience and productivity in the face of climate change, rapid urbanisation, degraded ecosystems and ageing infrastructure. Indicators can be valuable for guiding actions for improvement, but there is not yet an established index that measures the full suite of attributes that constitute water sensitive performance. This paper therefore presents the Water Sensitive Cities (WSC) Index, a new benchmarking and diagnostic tool to assess the water sensitivity of a municipal or metropolitan city, set aspirational targets and inform management responses to improve water sensitive practices. Its 34 indicators are organised into seven goals: ensure good water sensitive governance, increase community capital, achieve equity of essential services, improve productivity and resource efficiency, improve ecological health, ensure quality urban spaces, and promote adaptive infrastructure. The WSC Index design is a quantitative framework based on qualitative rating descriptions and a participatory assessment methodology, enabling local contextual interpretations of the indicators while maintaining a robust universal framework for city comparison and benchmarking. The paper demonstrates its application on three illustrative cases. Rapid uptake of the WSC Index in Australia highlights its value in helping stakeholders develop collective commitment and evidence-based priorities for action to accelerate their city's water sensitive transition. Early testing in cities in Asia, the Pacific and South Africa has also showed the potential of the WSC Index internationally.

Water Sensitive Cities Index: A diagnostic tool to assess water sensitivity and guide management actions.

Cities are wrestling with the practical challenges of transitioning urban water services to become water sensitive; capable of enhancing liveability, sustainability, resilience and productivity in the face of climate change, rapid urbanisation, degraded ecosystems and ageing infrastructure. Indicators can be valuable for guiding actions for improvement, but there is not yet an established index that measures the full suite of attributes that constitute water sensitive performance. This paper therefore presents the Water Sensitive Cities (WSC) Index, a new benchmarking and diagnostic tool to assess the water sensitivity of a municipal or metropolitan city, set aspirational targets and inform management responses to improve water sensitive practices. Its 34 indicators are organised into seven goals: ensure good water sensitive governance, increase community capital, achieve equity of essential services, improve productivity and resource efficiency, improve ecological health, ensure quality urban spaces, and promote adaptive infrastructure. The WSC Index design as a quantitative framework based on qualitative rating descriptions and a participatory assessment methodology enables local contextual interpretations of the indicators, while maintaining a robust universal framework for city comparison and benchmarking. The paper demonstrates its application on three illustrative cases. Rapid uptake of the WSC Index in Australia highlights its value in helping stakeholders develop collective commitment and evidence-based priorities for action to accelerate their city's water sensitive transition. Early testing in cities in Asia and the Pacific has also showed the potential of the WSC Index internationally.

Modelling transitions in urban water systems.

Long term planning of urban water infrastructure requires acknowledgement that transitions in the water system are driven by changes in the urban environment, as well as societal dynamics. Inherent to the complexity of these underlying processes is that the dynamics of a system's evolution cannot be explained by linear cause-effect relationships and cannot be predicted under narrow sets of assumptions. Planning therefore needs to consider the functional behaviour and performance of integrated flexible infrastructure systems under a wide range of future conditions. This paper presents the first step towards a new generation of integrated planning tools that take such an exploratory planning approach. The spatially explicit model, denoted DAnCE4Water, integrates urban development patterns, water infrastructure changes and the dynamics of socio-institutional changes. While the individual components of the DAnCE4Water model (i.e. modules for simulation of urban development, societal dynamics and evolution/performance of water infrastructure) have been developed elsewhere, this paper presents their integration into a single model. We explain the modelling framework of DAnCE4Water, its potential utility and its software implementation. The integrated model is validated for the case study of an urban catchment located in Melbourne, Australia.

Water scarcity and institutional change: lessons in adaptive governance from the drought experience of Perth, Western Australia.

Urban water systems will be increasingly challenged under future climates and global pressures. Meeting challenges by reconfiguring water systems to integrate supplies and deliver multifunctional uses is technically well described. Adjusting the institutions that frame the management of these systems is not well operationalized in practice or conceptualized in theory. This study seeks to address this gap through an institutional analysis of Perth, Australia, a city where drought crisis has put under pressure both management practices and the institutional setting that underlies them. The study found that while trusted practices moderated water scarcity, the stability of the institutional setting may not facilitate a shift toward adaptable institutional configurations suited to future conditions. The results identified three key ingredients for a flexible institutional setting: (i) feedbacks in the system through better information management, (ii) reflexive dialogue and strategic use of projects to generate greater learning opportunities, and (iii) policy level support for sector-wide collaboration through progressive agendas, incentives for innovation and capacity building in stakeholder and community engagement. Further, the results suggest that a deeper understanding of institutional dynamics is needed to enable adaptive governance. The paper provides an analytical framework for diagnosing how greater adaptive capacity might be mobilized through influencing these dynamics.

Enabling sustainable urban water management through governance experimentation.

A shift towards sustainable urban water management is widely advocated but poorly understood. There is a growing body of literature claiming that social learning is of high importance in restructuring conventional systems. In particular, governance experimentation, which explicitly aims for social learning, has been suggested as an approach for enabling the translation of sustainability ideas into practice. This type of experimentation requires a very different dynamic within societal relations and necessitates a changed role for professionals engaged in such a process. This empirically focused paper investigates a contemporary governance experiment, the Cooks River Sustainability Initiative, and determines its outcome in terms of enabling social learning for attaining sustainable water practice in an urban catchment. Drawing on the qualitative insights of the actors directly involved in this novel process, this paper provides evidence of changes in individual and collective understanding generated through diverse forms of social interaction. Furthermore, the research reveals perceived key-factors that foster and/or hamper the execution of this new form of experimentation, including project complexity, resource intensity and leadership. Overall, this paper highlights that, while implementation of governance experimentation in a conventional setting can be highly challenging, it can also be highly rewarding in terms of learning.

[Pulmonary hypertension due to left heart disease: recommendations of the Cologne Consensus Conference 2010]. / Pulmonale Hypertonie bei Linksherzerkrankungen: Empfehlungen der Kölner Konsensus-Konferenz 2010.

The 2009 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension have been adopted for Germany. While the guidelines contain detailed recommendations regarding pulmonary arterial hypertension (PAH), they contain only a relatively short paragraph on other, much more frequent forms of PH such as PH due to left heart disease. Despite the lack of data, targeted PAH treatments are increasingly being used for PH associated with left heart disease. This development is of concern. On the other hand, PH is a frequent problem that is highly relevant for morbidity and mortality in patients with left heart disease, so that it may be speculated whether selected patients may benefit from targeted PH therapy. It that sense, the practical implementation of the European Guidelines in Germany requires the consideration of several specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2010, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to PH due to left heart disease. This commentary summarizes the results and recommendations of this working group.

[A careful course of action in a conflict regarding useful treatment of a newborn infant with severe brain damage]. / Zorgvuldige handelwijze bij een conflict over zinvol handelen bij een pasgeborene met ernstige cerebrale beschadiging.

In a newborn female infant, it was concluded that severe perinatal asphyxia had caused such extensive cerebral damage that further medical treatment was useless. Based on their religious beliefs, the parents disagreed, despite the fact that the requested second opinions supported the conclusion of the medical staff. Since the parents persisted, a period of inurement was agreed upon during which reanimation would be performed if necessary. After several months, there was no change in the attitude of the parents towards the policy not to reanimate, even though it was clear that there was no improvement whatsoever in the patient's neurological status, while everyone agreed that she showed signs of increased suffering. The decision regarding the determination of a situation in which further medical treatment was useless was re-evaluated carefully. In a legal procedure started by the parents, the judge supported the decision of the attending physicians. In order to prevent the parents from taking their child home, in which case a situation could arise in which she would be deprived of adequate sedation or analgesia, which the attending physicians were obliged to provide, the Dutch Child Protection Council was consulted and the parents were deprived of their parental authority. Ultimately, the patient died suddenly due to respiratory and circulatory arrest without another situation in which reanimation might have been indicated.

Frequency-resolved pump-probe characterization of femtosecond infrared pulses.

A novel method for ultrashort IR pulse characterization is presented. The technique utilizes a frequency-resolved pump-probe geometry that is common in applications of ultrafast spectroscopy, without any modifications of the setup. The experimental demonstration of the method was carried out to characterize 70-fs IR pulses centered at 3 microm .

[Liver damage associated with the combination drug amoxicillin-clavulanic acid (Augmentin)]. / Leverbeschadiging in verband met de geneesmiddelencombinatie amoxicilline-clavulaanzuur (Augmentin).

OBJECTIVE: To describe the case histories of patients with liver damage associated with the antibacterial combination amoxicillin-clavulanic acid. DESIGN: Descriptive. SETTING: University Institute for General Practice, Rotterdam, the Netherlands. METHOD: All reports (n = 40) of hepatic injury, attributed to amoxicillin-clavulanic acid (causal relationship 'possible', 'probable' or 'certain') and received by the Drug Safety Unit of the Inspectorate for Health Care since the registration of the combination (1982) until August 1996 were described and evaluated. RESULTS: The reports concerned 28 men and 12 women with an average age of 61 years who had used the drug mostly for a respiratory tract infection. The latency period between first in-take and onset of the reaction was 3 weeks on average. The mean duration of hepatic injury was approximately 6 weeks. The liver injury resolved fully. Five patients had had the reaction on more than one occasion. The main symptoms were jaundice, nausea, pruritus and abdominal pain. The pattern of hepatic injury was mostly cholestatic or mixed hepatocellular-cholestatic. CONCLUSION: Since liver damage to amoxicillin-clavulanic acid appears to be infrequent, this adverse effect is probably not caused by amoxicillin alone. The risk of liver damage to amoxicillin-clavulanic acid is highest in elderly patients treated with the combination on several occasions. Doctors should restrict the use of this combination to the treatment of infections with amoxicillin-resistant bacteria.

Cu accumulation in Lumbricus rubellus under laboratory conditions compared with accumulation under field conditions.

Experiments were performed to determine Cu accumulation in earthworms under laboratory conditions using soil from a Cu-contaminated site, followed by field experiments in this contaminated site. The aims of the laboratory experiments were (a) to determine Cu accumulation rate, (b) to determine the effect of soil Cu content on the steady-state concentration, and (c) to evaluate the effect of soil moisture on accumulation. The field experiments were performed to evaluate the use of accumulation data obtained from laboratory experiments for prediction of accumulation under field conditions. In the laboratory experiment, earthworms (Lumbricus rubellus) were introduced into four homogeneously mixed Cu-contaminated soils and a reference soil. The total extractable Cu content in the soil (Cu(T)) varied from 10 to 130 mg kg-1, soil pH varied from 4.0 to 5.0, and soil moisture content was set to approximately 25, 35, and 45% of the dry weight for each treatment. The tissue Cu concentration (Cuw) was determined by sampling earthworms after 1, 7, 14, 28, and 56 days. In the field experiment, 500 earthworms were introduced at four different Cu-contaminated locations at a contaminated arable field. After 14, 28, and 70 days, earthworms were sampled to determine Cuw. In both experiments, soil Cu contents significantly affected Cuw. Soil moisture only significantly affected Cu accumulation for the wettest soil. Under laboratory conditions, a steady state did not seem to be achieved after 56 days; the Cu accumulation can be described by the toxicokinetic one-compartment model. The field experiment was considerably affected by variation in soil temperature resulting in significant fluctuations in tissue Cu concentrations. The tissue Cu accumulation was significantly correlated to the CuT, which is in agreement with the results from the laboratory experiments. Variance of Cuw at Day 14 in earthworms from the field experiments was significantly larger than in the worms from the laboratory experiment. At Day 28, the differences were not significant.

Cu accumulation in the earthworm Dendrobaena veneta in a heavy metal (Cu, Pb, Zn) contaminated site compared to Cu accumulation in laboratory experiments.

Earthworms (Dendrobaena veneta) were exposed to heavy metal contaminated soil from a field site under both laboratory and field conditions. In the laboratory study, D. veneta were analysed for Cu after 2 weeks' exposure. The tissue Cu concentration (Cu(W)) increased proportionally with the total extractable soil Cu content (Cu(T)) in soils that contained less than 150 mg Cu kg(-1). In D. veneta exposed to soils containing more than Cu(T) = 150 mg kg(-1), however, we observed no further increase in Cu(W). In a 64-m(2) field plot at a contaminated site, 81 soil samples were taken and analysed for Cu, Pb, Zn and pH. In June 1994, 1000 D. veneta were homogeneously distributed in the plot and sampled after 1, 2 and 5 weeks to analyse for Cu. Additionally, 2000 D. veneta were introduced in September 1994 and sampled after 1, 2 and 4 weeks. At locations where earthworms were removed, the soil Cu content was estimated by disjunctive kriging. Cu concentration factors (ratio of Cu(W) to Cu(T)) in the field experiment were in excellent agreement with those of the laboratory experiment. This indicates that, with a sufficiently high sampling density, it may be feasible to predict earthworm Cu accumulation in the field using a concentration factor determined in the laboratory.

Effect of Cd or Pb addition to Cu-contaminated soil on tissue Cu accumulation in the earthworm, Dendrobaena veneta.

Generally, soil heavy metal contamination consists of a mixture of heavy metals. Soil chemical properties and interaction with other pollutants in soil affect the external heavy metal bioavailability. Moreover, interaction with other pollutants accumulated in organisms may change the toxicity of each pollutant. Therefore, the hypotheses was tested that addition of Cd or Pb to Cu-contaminated soil would lead to an increase in tissue Cu accumulation in the earthworm, Dendrobaena veneta, caused by (i) induction of metallothionein by Cd, or (ii) an increase in Cu concentration in soil solution due to the exchange of adsorbed Cu for Pb. Tissue heavy metal concentrations were determined after exposure in contaminated soils for 3 or 21 days. Considerable amounts of Cu, Cd, and Pb were accumulated, indicating that these heavy metals were available for uptake by D. veneta. Both Cd and Pb, however, did not significantly affect tissue Cu accumulation.

A critical comparison of methods to quantify stratum corneum removed by tape stripping.

Skin surface stripping with adhesive tape has been used to study the barrier function of the stratum corneum. Usually, the amount of stratum corneum removed by stripping is not linearly proportional to the number of strips removed. The generally accepted quantitative method to determine the amount of stratum corneum material on a tape strip is weighing. This method however has certain drawbacks, it is time consuming and laborious because tape strips have to be weighed twice and sometimes it cannot be used to determine concentration profiles in the skin of active substances in topically applied vehicles. In this paper, the accuracy and reliability of an alternative method to determine the amount of stratum corneum removed by tape stripping of the skin was investigated and compared to weighing. It is based on the spectrophotometric examination of the tape. The light absorption by the proteins on the tape is correlated to the weight of the stratum corneum material. This method was found to be easier and faster than weighing, but it was less reliable because the light scattering of the stratum corneum on the tape largely overshadowed the absorption of the proteins. The light scattering showed a linear increase with an increasing amount of material on the tape, but with a large variability, resulting in calibration curves with correlations of 0.8400. However, direct spectroscopic analysis of stratum corneum tape strips has some distinct advantages even if it cannot be used for the exact quantification of stratum corneum proteins. With direct spectroscopic measurements, a tape strip can be laterally examined to inspect its homogeneity. Direct spectroscopic measurements on tape strips might also be employed to investigate the lateral and in-depth distribution of strongly light-absorbing substances in the stratum corneum.