Kuiper Medical Instruments (Netherlands)

Water fixtures can be involved in hospital outbreaks with multi-resistant pathogens. To document an outbreak of a Verona integron-encoded metallo-β-lactamase type 2-producing carbapenem-resistant Pseudomonas aeruginosa (CRPA-VIM) and evaluate infection control measures. Additionally, to overview waterborne outbreaks involving multi-resistant pathogens in Dutch healthcare institutions. Epidemiologic analysis, selective culturing, PCR, and whole-genome sequencing (WGS) identified the outbreak sources. National surveillance databases were consulted. In December 2023, three ICU patients tested positive for CRPA-VIM with multi-locus sequence type (MLST) ST111. Contaminated sinks were identified as the source. Despite interventions, a new cluster of five CRPA-VIM-positive patients emerged in March-April 2024. WGS linked this to a decommissioned sink (November 2021) and two patients (December 2021 and April 2023). Contact tracing and source investigations found no interpatient transmission; sinks were identified as the sole source. Measures, including contact precautions, intensified cleaning and hygiene procedures, retraining, installing and frequently replacing splash- and aerosol-reducing inlets, and faucet modifications failed to halt the transmission. No new cases occurred after the removal of all water fixtures in the ICU patient rooms. The outbreak strain was unique to the hospital and showed no genetic clustering in the national surveillance. Nationally, three to five waterborne outbreaks with highly resistant micro-organisms in hospitals are reported annually. CRPA-VIM was transmitted from sinks to ICU patients without interpatient transmission. Infection control requires comprehensive surveillance of patients and the environment. A water-restricted and drain-free environment ended the outbreak. Future hospital design should minimize contamination from drains and sinks to reduce the nosocomial infection risk.

ObjectiveOur objective was to explore whether the extension of the PROMIS item bank Ability to Participate in Social Roles and Activities (APSRA) with new items would result in more effective targeting (i.e., selecting items that are appropriate for each individual's trait level), and more reliable measurements across all latent trait levels.MethodsA sample of 1,022 Dutch adults completed all 35 items of the original item bank plus 17 new items (in Dutch). The new items presented in this publication have been translated provisionally from Dutch into English for presentation purposes. We evaluated the basic IRT assumptions unidimensionality, local independence, and monotonicity. Furthermore, we examined the item parameters, and assessed differential item functioning (DIF) for sex, education, region, age, and ethnicity. In addition, we compared the test information functions, item parameters, and θ scores, for the original and extended item bank in order to assess whether the measurement range had improved.ResultsWe found that the extended item bank was compatible with the basic IRT assumptions and showed good reliability. Moreover, the extended item bank improved the measurement in the lower trait range, which is important for reliably assessing functioning in clinical populations (i.e., persons reporting lower levels of participation).ConclusionWe extended the PROMIS-APSRA item bank and improved its psychometric quality. Our study contributes to PROMIS measurement innovation, which allows for the addition of new items to existing item banks, without changing the interpretation of the scores and while maintaining the comparability of the scores with other PROMIS instruments.

The alternating copolymerization of biorenewable limonene dioxide with carbon dioxide (CO2 ) catalyzed by a zinc β-diiminate complex is reported. The chemoselective reaction results in linear amorphous polycarbonates that carry pendent methyloxiranes and exhibit glass transition temperatures (Tg ) up to 135 °C. These polycarbonates can be efficiently modified by thiols or carboxylic acids in combination with lithium hydroxide or tetrabutylphosphonium bromide as catalysts, respectively, without destruction of the main chain. Moreover, polycarbonates bearing pendent cyclic carbonates can be quantitatively prepared by CO2 insertion catalyzed by lithium bromide.

Introduction: Tolerogenic dendritic cells (DCs) have been previously described to protect against atherosclerosis. A tolerogenic phenotype in DCs can be induced by apoptotic cell clearance and these DCs can prevent inflammatory responses. In this study, we took advantage of the fact that oxidized low-density lipoprotein (oxLDL) induces apoptosis in DCs. These oxLDL-induced apoptotic DCs (apop-DCs) enabled us to deliver an atherosclerosis-specific antigen to DCs in the context of regulatory signals. Hypothesis: We hypothesized that an adoptive transfer of apop-DCs would limit immune responses and thereby reduce atherosclerosis. Methods and Results: In vitro DCs pre-exposed to apop-DCs showed significantly less pro-inflammatory cytokines IL-6 (2493±73 vs. 1500±95 pg/mL) and TNF-α (311±12 vs. 30±7 pg/mL), but significantly increased anti-inflammatory IL-10 production (12±12 vs. 106±11 pg /mL) in response to LPS, compared to control DCs. Moreover, these DCs resulted in a dramatic reduction of T cell proliferation, accompanied by an about 8-fold decrease of Th1 cells, while regulatory T cells (Tregs) were 4.5-fold increased. Adoptive transfer of apop-DCs to LDLrKO mice prior to Western-type diet resulted in tolerogenic splenic DCs and increased circulating Tregs. Moreover, we determined a decreased proliferative capacity of splenic T cells and found less adventitial T cells in the aortic root. Serum IL-10 levels were significantly increased, while TNF- levels were reduced. Interestingly, we observed a 32% decrease in monocyte numbers, with 13% less Ly-6C hi and 14% less CCR2 + monocytes, and a 48% decrease in serum CCL2 levels. This translated into significantly less lesional macrophages in the aortic root. The overall reduced inflammatory status upon apop-DC-treatment translated into a 40% reduction in aortic root lesion size. Conclusions: We are the first to show the potential of apop-DC-treatment for atherosclerosis. In the future treatment of patients with autologous oxLDL-induced apop-DCs may prove a safe and very efficient treatment of atherosclerosis and acute vascular syndromes.