Use of other antimicrobial drugs is associated with trimethoprim resistance in patients with urinary tract infections caused by E. coli.

In recent years, high frequencies of trimethoprim resistance in urinary tract infections (UTIs) caused by E. coli are have been reported. Co-resistance to other antimicrobial drugs may play a role in this increase. Therefore, we investigated whether previous use of other antimicrobial drugs was associated with trimethoprim resistance. We conducted a nested case-control study with urinary cultures with E. coli from participants of the Rotterdam Study sent in by general practitioners to the regional laboratory between 1 January 2000 and 1 April 2016. Multivariable logistic regression analysis was performed to study the association between prior prescriptions of several antimicrobial drug groups and trimethoprim resistance using individual participant data. Urinary cultures of 1264 individuals with a UTI caused by E. coli were included. When adjusted for previous other antimicrobial drug use, a history of > 3 prescriptions of extended-spectrum penicillins (OR 1.68; 95% CI 1.10-2.55) was significantly associated with trimethoprim resistance of E. coli as was the use of > 3 prescriptions of sulfonamides and trimethoprim (OR 2.22; 95% CI 1.51-3.26). The use of > 3 prescriptions of nitrofuran derivatives was associated with a lower frequency of trimethoprim resistance (OR 0.60; 95% CI 0.39-0.92), after adjustment for other antimicrobial drug prescriptions. We found that previous use of extended-spectrum penicillins is associated with trimethoprim resistance. On the contrary, previous nitrofurantoin use was associated with a lower frequency of trimethoprim resistance. Especially in individuals with recurrent UTI, co-resistance should be taken into account and susceptibility testing before starting trimethoprim should be considered.

Clinical and virologic follow-up in perinatally HIV-1-infected children and adolescents in Madrid with triple-class antiretroviral drug-resistant viruses.

Drug resistance mutations compromise the success of antiretroviral treatment in human immunodeficiency virus type 1 (HIV-1)-infected children. We report the virologic and clinical follow-up of the Madrid cohort of perinatally HIV-infected children and adolescents after the selection of triple-class drug-resistant mutations (TC-DRM). We identified patients from the cohort carrying HIV-1 variants with TC-DRM to nucleoside reverse transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors and protease inhibitors according to IAS-USA-2013. We recovered pol sequences or resistance profiles from 2000 to 2011 and clinical-immunologic-virologic data from the moment of TC-DRM detection until December 2013. Viruses harbouring TC-DRM were observed in 48 (9%) of the 534 children and adolescents from 2000 to 2011, rising to 24.4% among those 197 with resistance data. Among them, 95.8% were diagnosed before 2003, 91.7% were Spaniards, 89.6% carried HIV-1-subtype B and 75% received mono/dual therapy as first regimen. The most common TC-DRM present in ≥50% of them were D67NME, T215FVY, M41L and K103N (retrotranscriptase) and L90M (protease). The susceptibility to darunavir, tipranavir, etravirine and rilpivirine was 67.7%, 43.7%, 33.3% and 33.3%, respectively, and all reported high resistance to didanosine, abacavir and nelfinavir. Despite the presence of HIV-1 resistance mutations to the three main antiretroviral families in our paediatric cohort, some drugs maintained their susceptibility, mainly the new protease inhibitors (tipranavir and darunavir) and nonnucleoside reverse transcriptase inhibitors (etravirine and rilpivirine). These data will help to improve the clinical management of HIV-infected children with triple resistance in Spain.

Haptic gas pedal feedback.

Active driver support systems either automate a control task or present warnings to drivers when their safety is seriously degraded. In a novel approach, utilising neither automation nor discrete warnings, a haptic gas pedal (accelerator) interface was developed that continuously presents car-following support information, keeping the driver in the loop. This interface was tested in a fixed-base driving simulator. Twenty-one drivers between the ages of 24 and 30 years participated in a driving experiment to investigate the effects of haptic gas pedal feedback on car-following behaviour. Results of the experiment indicate that when haptic feedback was presented to the drivers, some improvement in car-following performance was achieved, while control activity decreased. Further research is needed to investigate the effectiveness of the system in more varied driving conditions. Haptics is an under-used modality in the application of human support interfaces, which usually draw on vision or hearing. This study demonstrates how haptics can be used to create an effective driver support interface.

Explaining conversation rules to children: an intervention study to facilitate children's accurate responses.

In the past few years there has been increased concern over the role of social influences on children's reports during interviews. It is argued that the number of wrong answers can be reduced by explaining a set of social rules of conversation to children at the beginning of an interview. In the present experiment, the effects of two conversation rules were tested. Children were informed that (a) "I-don't-know" is an acceptable answer, and (b) the interviewer would not be able to help them in answering the questions. A total of 114 children, aged 4 to 10, watched a staged event and were interviewed afterwards. The two factors were systematically varied in the experiment by utilizing a 2 x 2 factorial design. The results supported the hypotheses that introduction of these rules would reduce suggestibility. Our findings have implications for interviewing child witnesses.