• The antimicrobial resistome in relation to antimicrobial use and biosecurity in pig farming, a metagenome-wide association study in nine European countries.

      Van Gompel, Liese; Luiken, Roosmarijn E C; Sarrazin, Steven; Munk, Patrick; Knudsen, Berith E; Hansen, Rasmus B; Bossers, Alex; Aarestrup, Frank M; Dewulf, Jeroen; Wagenaar, Jaap A; Mevius, Dik J; Schmitt, Heike; Heederik, Dick J J; Dorado-García, Alejandro; Smit, Lidwien A M (2019-04-01)
      Previous studies in food-producing animals have shown associations between antimicrobial use (AMU) and resistance (AMR) in specifically isolated bacterial species. Multi-country data are scarce and only describe between-country differences. Here we investigate associations between the pig faecal mobile resistome and characteristics at the farm-level across Europe. A cross-sectional study was conducted among 176 conventional pig farms from nine European countries. Twenty-five faecal samples from fattening pigs were pooled per farm and acquired resistomes were determined using shotgun metagenomics and the Resfinder reference database, i.e. the full collection of horizontally acquired AMR genes (ARGs). Normalized fragments resistance genes per kilobase reference per million bacterial fragments (FPKM) were calculated. Specific farm-level data (AMU, biosecurity) were collected. Random-effects meta-analyses were performed by country, relating farm-level data to relative ARG abundances (FPKM). Total AMU during fattening was positively associated with total ARG (total FPKM). Positive associations were particularly observed between widely used macrolides and tetracyclines, and ARGs corresponding to the respective antimicrobial classes. Significant AMU-ARG associations were not found for β-lactams and only few colistin ARGs were found, despite high use of these antimicrobial classes in younger pigs. Increased internal biosecurity was directly related to higher abundances of ARGs mainly encoding macrolide resistance. These effects of biosecurity were independent of AMU in mutually adjusted models. Using resistome data in association studies is unprecedented and adds accuracy and new insights to previously observed AMU-AMR associations. Major components of the pig resistome are positively and independently associated with on-farm AMU and biosecurity conditions.
    • GloPID-R report on Chikungunya, O'nyong-nyong and Mayaro virus, part I: Biological diagnostics.

      Pezzi, L; Reusken, C B; Weaver, S C; Drexler, J F; Busch, M; LaBeaud, A D; Diamond, M S; Vasilakis, N; Drebot, M A; Siqueira, A M; Ribeiro, G S; Kohl, A; Lecuit, M; Ng, L F P; Gallian, P; de Lamballerie, X; Boyer, S; Brasil, P; Diallo, M; Failloux, A B; Jaenisch, T; Lourenço-de-Oliveira, R; Neyts, J; Rios, M; Rodriguez-Morales, A J; Rosa-Freitas, M G; Sall, A; Simmons, G; Simon, F; Vega Rua, A (2019-03-21)
      The GloPID-R (Global Research Collaboration for Infectious Disease Preparedness) Chikungunya (CHIKV), O'nyong-nyong (ONNV) and Mayaro virus (MAYV) Working Group is investigating the natural history, epidemiology and medical management of infection by these viruses, to identify knowledge gaps and to propose recommendations for direct future investigations and rectification measures. Here, we present the first report dedicated to diagnostic aspects of CHIKV, ONNV and MAYV. Regarding diagnosis of the disease at the acute phase, molecular assays previously described for the three viruses require further evaluation, standardized protocols and the availability of international standards representing the genetic diversity of the viruses. Detection of specific IgM would benefit from further investigations to clarify the extent of cross-reactivity among the three viruses, the sensitivity of the assays, and the possible interfering role of cryoglobulinaemia. Implementation of reference panels and external quality assessments for both molecular and serological assays is necessary. Regarding sero-epidemiological studies, there is no reported high-throughput assay that can distinguish among these different viruses in areas of potential co-circulation. New specific tools and/or improved standardized protocols are needed to enable large-scale epidemiological studies of public health relevance to be performed. Considering the high risk of future CHIKV, MAYV and ONNV outbreaks, the Working Group recommends that a major investigation should be initiated to fill the existing diagnostic gaps.
    • When are Adverse Outcome Pathways and Associated Assays "Fit for Purpose" for Regulatory Decision-Making and Management of Chemicals?

      Coady, Katie; Browne, Patience; Embry, Michelle; Hill, Thomas; Leinala, Eeva; Steeger, Thomas; Maślankiewicz, Lidka; Hutchinson, Tom (2019-03-25)
      There have been increasing demands for chemical hazard and risk assessments in recent years. Chemical companies have expanded internal product stewardship initiatives, and jurisdictions have increased the regulatory requirements for the manufacture and sale of chemicals. There has also been a shift in chemical toxicity evaluations within the same timeframe with new methodologies being developed to improve chemical safety assessments for both human health and the environment. With increased needs for chemical assessments coupled with more diverse data streams from new technologies, regulators and others tasked with chemical management activities are faced with increasing workloads and more diverse types of data to consider. The Adverse Outcome Pathway (AOP) framework can be applied in different scenarios to integrate data and guide chemical assessment and management activities. In this paper, scenarios of how AOPs can be used to guide chemical management decisions during research and development, chemical registration, and subsequent regulatory activities like prioritization and risk assessment are considered. Furthermore, specific criteria (e.g. the type and level of AOP complexity, confidence in the AOP, as well as external review and assay validation) are proposed to examine whether AOPs and associated tools are fit for purpose when applied in different contexts. Certain toxicity pathways are recommended as priority areas for AOP research and development, and the continued use of AOPs and defined approaches in regulatory activities are recommended. Furthermore, a call for increased outreach, education and enhanced use of AOP databases are proposed to increase their utility in chemicals management. This article is protected by copyright. All rights reserved.
    • Prediction and validation of immunogenic domains of pneumococcal proteins recognized by human CD4 T-cells.

      van de Garde, Martijn D B; van Westen, Els; Poelen, Martien C M; Rots, Nynke Y; van Els, Cécile A C M (2019-03-25)
    • Genospecies of Borrelia burgdorferi sensu lato detected in 16 mammal species and questing ticks from northern Europe.

      Mysterud, Atle; Stigum, Vetle M; Jaarsma, Ryanne I; Sprong, Hein (2019-03-25)
      Lyme borreliosis is the most common vector-borne zoonosis in the northern hemisphere, and the pathogens causing Lyme borreliosis have distinct, incompletely described transmission cycles involving multiple host groups. The mammal community in Fennoscandia differs from continental Europe, and we have limited data on potential competent and incompetent hosts of the different genospecies of Borrelia burgdorferi sensu lato (sl) at the northern distribution ranges where Lyme borreliosis is emerging. We used qPCR to determine presence of B. burgdorferi sl in tissue samples (ear) from 16 mammalian species and questing ticks from Norway, and we sequenced the 5S-23 S rDNA intergenic spacer region to determine genospecies from 1449 qPCR-positive isolates obtaining 423 sequences. All infections coming from small rodents and shrews were linked to the genospecies B. afzelii, while B. burgdorferi sensu stricto (ss) was only found in red squirrels (Sciurus vulgaris). Red squirrels were also infected with B. afzelii and B. garinii. There was no evidence of B. burgdorferi sl infection in moose (Alces alces), red deer (Cervus elaphus) or roe deer (Capreolus capreolus), confirming the role of cervids as incompetent hosts. In infected questing ticks in the two western counties, B. afzelii (67% and 75%) dominated over B. garinii (27% and 21%) and with only a few recorded B. burgdorferi ss and B. valaisiana. B. burgdorferi ss were more common in adult ticks than in nymphs, consistent with a reservoir in squirrels. Our study identifies potential competent hosts for the different genospecies, which is key to understand transmission cycles at high latitudes of Europe.
    • Visual tools to assess the plausibility of algorithm-identified infectious disease clusters: an application to mumps data from the Netherlands dating from January 2009 to June 2016.

      Soetens, Loes; Backer, Jantien A; Hahné, Susan; van Binnendijk, Rob; Gouma, Sigrid; Wallinga, Jacco (2019-03-01)
      IntroductionWith growing amounts of data available, identification of clusters of persons linked to each other by transmission of an infectious disease increasingly relies on automated algorithms. We propose cluster finding to be a two-step process: first, possible transmission clusters are identified using a cluster algorithm, second, the plausibility that the identified clusters represent genuine transmission clusters is evaluated.AimTo introduce visual tools to assess automatically identified clusters.MethodsWe developed tools to visualise: (i) clusters found in dimensions of time, geographical location and genetic data; (ii) nested sub-clusters within identified clusters; (iii) intra-cluster pairwise dissimilarities per dimension; (iv) intra-cluster correlation between dimensions. We applied our tools to notified mumps cases in the Netherlands with available disease onset date (January 2009 - June 2016), geographical information (location of residence), and pathogen sequence data (n = 112). We compared identified clusters to clusters reported by the Netherlands Early Warning Committee (NEWC).ResultsWe identified five mumps clusters. Three clusters were considered plausible. One was questionable because, in phylogenetic analysis, genetic sequences related to it segregated in two groups. One was implausible with no smaller nested clusters, high intra-cluster dissimilarities on all dimensions, and low intra-cluster correlation between dimensions. The NEWC reports concurred with our findings: the plausible/questionable clusters corresponded to reported outbreaks; the implausible cluster did not.ConclusionOur tools for assessing automatically identified clusters allow outbreak investigators to rapidly spot plausible transmission clusters for mumps and other human-to-human transmissible diseases. This fast information processing potentially reduces workload.
    • Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014.

      Karo, Basel; Kohlenberg, Anke; Hollo, Vahur; Duarte, Raquel; Fiebig, Lena; Jackson, Sarah; Kearns, Cathriona; Ködmön, Csaba; Korzeniewska-Kosela, Maria; Papaventsis, Dimitrios; Solovic, Ivan; van Soolingen, Dick; van der Werf, Marieke J (2019-03-01)
      Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002-14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6-0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2-1.5), male sex (OR: 1.3; 95% CI: 1.1-1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1-1.4), positive HIV status (OR: 3.3; 95% CI: 1.6-6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5-2.2).
    • The Vulnerability Scan, a Web Tool to Increase Institutional Biosecurity Resilience.

      Meulenbelt, Stephanie E; van Passel, Mark W J; de Bruin, Arnout; van den Berg, Linda M; Schaap, Mirjam M; Rutjes, Saskia A; Jacobi, André J; Agterberg, Marja C; de Hoog, Carin; van Willigen, Gijsbert; Kampert, Evelien; Heres, Jan H J; van den Berg, Ruud; van den Berg, Harold H J L; Bleijs, Diederik A (2019-01-01)
      The importance of vigilance within organizations working with high-risk biological material receives increasing attention. However, an in-depth and comprehensive tool, dedicated to increase awareness of potential risks and to assess an organization's current biosecurity vulnerabilities, has not been available yet. We developed the "Biosecurity Vulnerability Scan," a web tool that identifies biosecurity gaps in an organization based on eight biosecurity pillars of good practice. Although the tool aims primarily to assist biosafety and biosecurity officers, it can also be useful to researchers working with dangerous pathogens, their principal investigators, management, or those responsible for security issues in the life sciences. Results are only stored locally and are provided in an "overview report," which includes information on relevant risks and control measures. This can support well-substantiated decision-making on strengthening biosecurity measures within a specific organization. With this article, we aim to support institutes to increase their overall security resilience and to improve institutional biosecurity in particular by providing practical recommendations. The Biosecurity Vulnerability Scan is available at www.biosecurityvulnerabilityscan.nl.
    • Harmonized methodology to assess chronic dietary exposure to residues from compounds used as pesticide and veterinary drug.

      Arcella, Davide; Boobis, Alan; Cressey, Peter; Erdely, Holly; Fattori, Vittorio; Leblanc, Jean-Charles; Lipp, Markus; Reuss, Rainer; Scheid, Stefan; Tritscher, Angelika; Van der Velde-Koerts, Trijntje; Verger, Philippe (2019-03-28)
      Risk assessments for pesticide and veterinary drug residues in food are performed respectively by the Joint FAO/WHO Expert Meeting on Pesticide Residues (JMPR) and the Joint FAO/WHO Expert Committee on Food Additives (JECFA). The models used by the two Committees to assess chronic dietary exposure are based on different data and assumptions which may be confusing, particularly for risk managers, when the same compound is used to treat plants and animals. This publication details the results of combined chronic dietary exposure assessments for eight compounds used both as pesticide and veterinary drugs. It compares the results from models in use by JMPR and JECFA with those from national estimates performed by 17 countries. Results show that the JECFA model is better reflecting less than lifetime dietary exposure by considering consumption of children and high consumers. The JMPR model is a suitable model for estimating average chronic (lifetime) exposure to residues present in widely and regularly consumed staple commodities. However, it is suitable neither for estimating children's exposure nor more generally for assessing less than lifetime dietary exposure. In order to select the appropriate exposure model related to the occurrence of adverse effects i.e. effects occurring over less-than-lifetime or effects occurring only over lifetime, this paper proposes criteria to match the toxicological profile of the compound and the appropriate exposure scenarios. These approaches will continue to be harmonized to ensure the most scientifically sound basis for the risk assessment for pesticides and veterinary drug residues and consequently for other chemicals in food.
    • Cocreative Development of the QoL-ME: A Visual and Personalized Quality of Life Assessment App for People With Severe Mental Health Problems.

      Buitenweg, David C; Bongers, Ilja L; van de Mheen, Dike; van Oers, Hans Am; van Nieuwenhuizen, Chijs (2019-03-28)
      Quality of life (QoL) is a prominent outcome measure in mental health. However, conventional methods for QoL assessment rely heavily on language-based communication and therefore may not be optimal for all individuals with severe mental health problems. In addition, QoL assessment is usually based on a fixed number of life domains. This approach conflicts with the notion that QoL is influenced by individual values and preferences. A digital assessment app facilitates both the accessibility and personalization of QoL assessment and may, therefore, help to further advance QoL assessment among individuals with severe mental health problems. This study focused on the development of an innovative, visual, and personalized QoL assessment app for people with severe mental health problems: the QoL-ME. This study targeted 3 groups of individuals with severe mental health problems: (1) people with psychiatric problems, (2) people treated in forensic psychiatry, and (3) people who are homeless. A group of 59 participants contributed to the 6 iterations of the cocreative development of the QoL-ME. In the brainstorming stage, consisting of the first iteration, participants' previous experiences with questionnaires and mobile apps were explored. Participants gave their feedback on initial designs and wireframes in the second to fourth iterations that made up the design stage. In the usability stage that comprised the final 2 iterations, the usability of the QoL-ME was evaluated. In the brainstorming stage, participants stressed the importance of privacy and data security and of receiving feedback when answering questionnaires. Participants in the design stage indicated a preference for paging over scrolling, linear navigation, a clean and minimalist layout, the use of touchscreen functionality in various modes of interaction, and the use of visual analog scales. The usability evaluation in the usability stage revealed good to excellent usability.
    • Preschool teachers' perspective on how high noise levels at preschool affect children's behavior.

      Persson Waye, Kerstin; Fredriksson, Sofie; Hussain-Alkhateeb, Laith; Gustafsson, Johanna; van Kamp, Irene (2019-01-01)
      Early-age exposure to noise may have long-term health implications of which we have little knowledge of today. Age-specific hearing, learning inadequate coping strategies, and alterations in biological stress regulatory responses could play a role in the long-term health impacts. In Sweden about half a million children in the age between 1-5 years attend preschool. The noise exposure at preschools is intermittent and unpredictable and levels reach up to 84 dB LAeq (time indoors) with maximum levels of 118 dB LAF, mostly due to child activity. To increase the overall understanding of the possible implications of preschool noise environments for children, this paper describes children's behavioral and emotional reactions to and coping with their everyday sound environment from a teachers perspective. A postal questionnaire study performed in 2013-2014 with answers from 3,986 preschool teachers provided the data. Content analysis was combined with quantitative analysis. Eighty-two percent of the personnel considered that children's behavior was affected rather or very much by preschool noise. The most prevalent behaviors were categorized into: be heard, be distracted, show negative internal emotions, crowd, avoid, withdraw, be exhausted, and learning. The quantitative analyses confirmed an association between the perceived loudness and noise annoyance at preschool and affirmative reporting on noise affecting the children´s behavior. Age of the personnel, with the youngest age group reporting noise related behavior less often, and age distribution of the class, with 1-5 years old seeming less affected by noise, were also indicated, while pedagogic orientation was not a significant factor. Future studies should address the long-term health effects of these behaviors.
    • A Stepwise Approach to a National Hepatitis C Screening Strategy in Malaysia to Meet the WHO 2030 Targets: Proposed Strategy, Coverage, and Costs.

      Hiebert, Lindsey; Hecht, Robert; Soe-Lin, Shan; Mohamed, Rosmawati; Shabaruddin, Fatiha H; Syed Mansor, Syed Mukhtar; Dahlui, Maznah; Azzeri, Amirah; McDonald, Scott A (2019-03-25)
      In Malaysia, more than 330 000 individuals are estimated to be chronically infected with hepatitis C virus (HCV), but less than 2% have been treated to date. To estimate the required coverage and costs of a national screening strategy to inform the launch of an HCV elimination program. We designed an HCV screening strategy based on a "stepwise" approach. This approach relied on targeting of people who inject drugs in the early years, with delayed onset of widespread general population screening. Annual coverage requirements and associated costs were estimated to ensure that the World Health Organization elimination treatment targets were met. In total, 6 million individuals would have to be screened between 2018 and 2030. Targeting of people who inject drugs in the early years would limit annual screening coverage to less than 1 million individuals from 2018 to 2026. General population screening would have to be launched by 2026. Total costs were estimated at MYR 222 million ($58 million). Proportional to coverage targets, 60% of program costs would fall from 2026 to 2030.
    • Ticks and tick-borne diseases in the city: Role of landscape connectivity and green space characteristics in a metropolitan area.

      Heylen, D; Lasters, R; Adriaensen, F; Fonville, M; Sprong, H; Matthysen, E (2019-03-16)
      Green spaces in the city are important for human wellbeing, but are also zones in which humans can become infected with zoonotic diseases. Therefore, there is a need to understand how infection risk is related to green space characteristics, wildlife communities and connectivity with rural areas hosting reservoir populations of hosts. Our hypothesis is that wildlife hosts in urban green spaces, and thereby the prevalence of questing ticks and their Lyme disease causing pathogens (Borrelia burgdorferi s.l.), can be partly predicted based on green space characteristics as well as measures of connectivity to known source areas. We sampled ticks in twenty-two green spaces during Spring (2014 and 2016) and Autumn 2016, located along an urbanization gradient in Antwerp (Belgium). More than 18,000 m
    • Evaluating progress towards triple elimination of mother-to-child transmission of HIV, syphilis and hepatitis B in the Netherlands.

      Visser, Maartje; van der Ploeg, Catharina P B; Smit, Colette; Hukkelhoven, Chantal W P M; Abbink, Frithjofna; van Benthem, Birgit H B; Op de Coul, Eline L M (2019-03-29)
      In 2014 the World Health Organisation (WHO) established validation criteria for elimination of mother-to-child transmission (EMTCT) of HIV and syphilis. Additionally, the WHO set targets to eliminate hepatitis, including hepatitis B (HBV). We evaluated to what extent the Netherlands has achieved the combined WHO criteria for EMTCT of HIV, syphilis and HBV. Data of HIV, syphilis and HBV infections among pregnant women and children (born in the Netherlands with congenital infection) for 2009-2015, and data required to validate the WHO criteria were collected from multiple sources: the antenatal screening registry, the HIV monitoring foundation database, the Perinatal Registry of the Netherlands, the national reference laboratory for congenital syphilis, and national HBV notification data. Screening coverage among pregnant women was > 99% for all years, and prevalence of HIV, syphilis and HBV was very low. In 2015, prevalence of HIV, syphilis and HBV was 0.06, 0.06 and 0.29%, respectively. No infections among children born in the Netherlands were reported in 2015 for all three diseases, and in previous years only sporadic cases were observed In 2015, treatment of HIV positive pregnant women was 100% and HBV vaccination of children from HBV positive mothers was > 99%. For syphilis, comprehensive data was lacking to validate WHO criteria. In the Netherlands, prevalence of maternal HIV, syphilis and HBV is low and congenital infections are extremely rare. All minimum WHO criteria for validation of EMTCT are met for HIV and HBV, but for syphilis more data are needed to prove elimination.
    • Cumulative acquisition of pathogenicity islands has shaped virulence potential and contributed to the emergence of LEE-negative Shiga toxin-producing Escherichia coli strains.

      Montero, David Arturo; Canto, Felipe Del; Velasco, Juliana; Colello, Rocío; Padola, Nora Lia; Salazar, Juan Carlos; Martin, Carla San; Oñate, Angel; Blanco, Jorge; Rasko, David A; Contreras, Carmen; Puente, Jose Luis; Scheutz, Flemming; Franz, Eelco; Vidal, Roberto M (2019-01-01)
      Shiga toxin-producing Escherichia coli (STEC) are foodborne pathogens causing severe gastroenteritis, which may lead to hemolytic uremic syndrome. The Locus of Enterocyte Effacement (LEE), a Pathogenicity Island (PAI), is a major determinant of intestinal epithelium attachment of a group of STEC strains; however, the virulence repertoire of STEC strains lacking LEE, has not been fully characterized. The incidence of LEE-negative STEC strains has increased in several countries, highlighting the relevance of their study. In order to gain insights into the basis for the emergence of LEE-negative STEC strains, we performed a large-scale genomic analysis of 367 strains isolated worldwide from humans, animals, food and the environment. We identified uncharacterized genomic islands, including two PAIs and one Integrative Conjugative Element. Additionally, the Locus of Adhesion and Autoaggregation (LAA) was the most prevalent PAI among LEE-negative strains and we found that it contributes to colonization of the mice intestine. Our comprehensive and rigorous comparative genomic and phylogenetic analyses suggest that the accumulative acquisition of PAIs has played an important, but currently unappreciated role, in the evolution of virulence in these strains. This study provides new knowledge on the pathogenicity of LEE-negative STEC strains and identifies molecular markers for their epidemiological surveillance.
    • Quantifying the public's view on social value judgments in vaccine decision-making: A discrete choice experiment.

      Luyten, Jeroen; Kessels, Roselinde; Atkins, Katherine E; Jit, Mark; van Hoek, Albert Jan (2019-03-20)
      Vaccination programs generate direct protection, herd protection and, occasionally, side effects, distributed over different age groups. This study elicits the general public's view on how to balance these outcomes in funding decisions for vaccines. We performed an optimal design discrete choice experiment with partial profiles in a representative sample (N = 1499) of the population in the United Kingdom in November 2016. Using a panel mixed logit model, we quantified, for four different types of infectious disease, the importance of a person's age during disease, how disease was prevented-via direct vaccine protection or herd protection-and whether the vaccine induced side effects. Our study shows clear patterns in how the public values vaccination programs. These diverge from the assumptions made in public health and cost-effectiveness models that inform decision-making. We found that side effects and infections in newborns and children were of primary importance to the perceived value of a vaccination program. Averting side effects was, in any age group, weighted three times as important as preventing an identical natural infection in a child whereas the latter was weighted six times as important as preventing the same infection in elderly aged 65-75 years. These findings were independent of the length or severity of the disease, and were robust across respondents' backgrounds. We summarize these patterns in a set of preference weights that can be incorporated into future models. Although the normative significance of these weights remains a matter open for debate, our study can, hopefully, contribute to the evaluation of vaccination programs beyond cost-effectiveness.
    • Interactive effects of rice straw biochar and γ-AlO on immobilization of Zn.

      Wu, Ping; Cui, Peixin; Alves, Marcelo E; Peijnenburg, Willie J G M; Liu, Cun; Zhou, Dongmei; Wang, Hailong; Ok, Yong Sik; Wang, Yujun (2019-03-19)
      Biochar system technology has been proved as a sustainable remediation method for metal contaminated soils. However, little attention has been paid to the interaction between biochar and oxide minerals and their influence on metal immobilization in soils. In this study, batch-type Zn sorption experiments were conducted using the mixture of γ-Al
    • Importance of details in food descriptions in estimating population nutrient intake distributions.

      Zhang, Liangzi; Geelen, Anouk; Boshuizen, Hendriek C; Ferreira, José; Ocké, Marga C (2019-03-15)
      National food consumption surveys are important policy instruments that could monitor food consumption of a certain population. To be used for multiple purposes, this type of survey usually collects comprehensive food information using dietary assessment methods like 24-h dietary recalls (24HRs). However, the collection and handling of such detailed information require tremendous efforts. We aimed to improve the efficiency of data collection and handling in 24HRs, by identifying less important characteristics of food descriptions (facets) and assessing the impact of disregarding them on energy and nutrient intake distributions. In the Dutch National Food Consumption Survey 2007-2010, food consumption data were collected through interviewer-administered 24HRs using GloboDiet software in 3819 persons. Interviewers asked participants about the characteristics of each food item according to applicable facets. Food consumption data were subsequently linked to the food composition database. The importance of facets for predicting energy and each of the 33 nutrients was estimated using the random forest algorithm. Then a simulation study was performed to determine the influence of deleting less important facets on population nutrient intake distributions. We identified 35% facets as unimportant and deleted them from the total food consumption database. The majority (79.4%) of the percent difference between percentile estimates of the population nutrient intake distributions before and after facet deletion ranged from 0 to 1%, while 20% cases ranged from 1 to 5% and 0.6% cases more than 10%. We concluded that our procedure was successful in identifying less important food descriptions in estimating population nutrient intake distributions. The reduction in food descriptions has the potential to reduce the time needed for conducting interviews and data handling while maintaining the data quality of the survey.
    • A mobile application to collect daily data on pre-exposure prophylaxis adherence and sexual behaviour among men who have sex with men: use over time and comparability with conventional data collection.

      Finkenflügel, Renee N N; Hoornenborg, Elske; Achterbergh, Roel C A; Marra, Elske; Davidovich, Udi; de Vries, Henry J C; Prins, Maria; Schim van der Loeff, Maarten F (2019-03-14)
      We studied the use of a mobile application (app) to measure HIV Pre-Exposure Prophylaxis (PrEP) adherence and sexual behaviour, assessed determinants of app use, and we compared data in app and questionnaires. Men who have sex with men (MSM) participating in the Amsterdam PrEP project (AMPrEP) on daily or event-driven PrEP at the Public Health Service of Amsterdam completed data on sexual risk behaviour and PrEP adherence through three-monthly standard questionnaires and on a daily basis using the project's app. Regression analyses were used to assess factors associated with app use. Among those who reported ≥90% of data in the app, the number of PrEP pills taken and number of unknown casual sex partners were compared between the app and the questionnaires by Wilcoxon signed-rank test. Of all participants (n=374), 94% (352/374) reported data in the app at least once; 72% (261/362) reported data ≥90% of the days in the sixth month and 62% (222/359) in the 12th month following PrEP initiation.Factors associated with reporting data in the app were using daily PrEP and recent initiation of PrEP. The reported numbers of pills taken and unknown sexual partners were comparable between app and questionnaires. The AMPrEP app was used frequently, especially by those using a daily PrEP regimen. Data collected by app regarding adherence and sexual risk behaviour were consistent with questionnaire data among those who used the app consistently. An app is a promising tool to measure PrEP adherence and sexual risk behaviour.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.