For the data collection, a sociodemographic and clinicalassessment form and the Antiretroviral Treatment Adherence AssessmentQuestionnaire were used. For the data analysis, the software STATA version 11 wasused, through descriptive statistics, Fisher's chi-square exact test and theprobability test. men were predominant (79.7%), between 30 and 39 years of age (35.1%), low income(75.7%) and pulmonary tuberculosis (71.6%). Adherence to antiretroviral therapywas inappropriate in 78.1% of the men; 61.0% of single people; 47.0% unemployedand 76.5% among people gaining less than one minimum wage. A significantdifference was observed between compliance and length of use of antiretrovirals(p=0.018), sexual orientation (p=0.024) and number of children (p=0.029). the coinfected patients presented inappropriate adherence to the antiretrovirals,a fact that negatively affects the health conditions of the people living withHIV/tuberculosis coinfection. A statistically significant correlation was foundbetween the levels of adherence and some sociodemographic and clinicalcharacteristics. Mycobacterium tuberculosis.Infection by the Human Immunodeficiency Virus (HIV) has been considered one of the mainrisk factors for the development of active Tuberculosis (TB), based on a latentinfection in people infected with culosis..HIV infection represents a significant challenge for global TB control. TB is the secondmain cause of death by infectious diseases all over the world and the main cause amongpeople living with HIV. Approximately 13.0% of TB cases happen in people living withHIV..Compliance with TB and HIV/AIDS treatment is fundamental to control these infections as,despite being considered chronic infection, tuberculosis treatment takes between six andnine months, depending on the type of TB, while HIV/AIDS treatment lasts alifetime.. Resistance to tuberculostatic drugs, as well as the high risk oftransmitting the TB bacillus, emerged due to the abandonment and inappropriate use ofdrugs against TB. People living with HIV are at greater risk of reactivating the latenttuberculosis infection due to the deficient immune response. In coinfected people,mortality is commonly related with late diagnosis, as some people with HIV postponevisiting a health service out of fear of receiving an AIDS diagnosis.HIV/TB coinfection results in higher mortality rates than HIV infection only. Resistiagnosis..Concerning the disease evolution, the reduced survival of HIV/AIDS patients has beenobserved after the development of active TB. In addition, the HIV infection changes theTB infection, its clinical manifestation, the length of the treatment and tolerance oftuberculostatic drugs. As a result of correct treatment, however, approximately 90.0% ofcoinfected patients with active TB can be cured and discharged..Antiretroviral Therapy (ARVT) significantly reduces the risk of morbidity and mortalitydue to TB. A study appoints that the appropriate use of ARVT reduces the risk ofdeveloping TB by 65.0%, independently of the T CD4+ lymphocyte count..People being concomitantly treated for both diseases can be at risk of reduced adherenceto one or both treatments. The low compliance with TB and HIV treatment can lead to theincreased risk of drug resistance, relapses, death and, in addition, extend theinfectiousness..The characteristics frequently appointed in research concerning adherence to medicationrelated to different health conditions include patients' social, environmental, culturaland psychological aspects, as well as the characteristics intrinsic to thetreatment.In view of the above, the goals were to assess the compliance levels with antiretroviraltherapy in patients coinfected with HIV/tuberculosis and to correlate these levels withthe sociodemographic and clinical variables of the study population.A descriptive and cross-sectional study was undertaken at a public teaching and referralhospital for the diagnosis and treatment of infectious diseases in the State of Ceará.The data were collected in a consecutive period of six months, from September 2012 tillJanuary 2013.The population consisted of 74 people coinfected with HIV/TB and monitored at theservice's outpatient clinic, whose inclusion criteria were: age 18 years or older, maleor female, with a medical diagnosis of HIV and tuberculosis (HIV/TB coinfection),formally registered in the patient history. This number represented 90.2% of allcoinfected patients attended at the service during the research period.The participants were recruited for the study while attending their routine outpatientconsultation. The interviews were held at a private room, permitting the secrecy andconfidentiality of the information obtained.To collect the data, a sociodemographic and clinical assessment tool was used. Thevariables obtained from primary sources were: age, sex, self-referred color, education,occupation, income, marital situation, sexual orientation, number of children and numberof people living in the same home. The clinical data were: current serum status ofpartner, length of diagnosis of HIV infection, length of use of T CD4+ lymphocytecounts, viral load and form of exposure to tuberculosis.. In this study, for the purpose of the data analysis, considering thatFisher's exact chi-square test was used, adherence was classified as good/appropriateand strict (gross score ≥75) and inappropriate or low/insufficient (gross score ≤74).Inappropriate adherence is characterized by complete treatment abandonment or incorrectfollow-up.To assess the compliance with antiretroviral treatment, the Brazilian version of theAntiretroviral Treatment Adherence Assessment Questionnaire (CEAT-HIV) was used, a toolapplicable to people infected with HIV, containing 20 questions, in which the totalscore is obtained by adding up all item scores . The higher the score, the higher the degree of treatment compliance.The degree of compliance follows these categories: inappropriate or low/insufficient(gross score ≤74), good/appropriate (gross score between 75 and 79) and strict (grossscore ≥80)For the statistical analyses, the software STATA version 11.0 was used. Thesociodemographic and clinical characteristics were processed through descriptivestatistics, uni and bivariate frequency distributions and descriptive measures (averageand standard deviation). The p-values were obtained using Fisher's exact chi-square testand the probability test. Significance was set at 5.0% (p≤0.05).The study received approval from the Research Ethics Committee under Protocol 93.437,complying with the recommendations of National Health Council Resolution 466/2012.Among the 74 persons investigated, 79.7% were male. The predominant age range wasbetween 30 and 39 years (35.1%), with a mean age of 37.7 years (standarddeviation-sd=10.88), minimum age 20 years and maximum age 71 years.In the distribution of the self-referred color, mulatto individuals were predominant(58.1%). As to the marital status, 31.1% were married or lived with a fixed partner.Concerning the sexual orientation, 61.7% indicated they were heterosexual. Regardingeducation, 42.4% reported they had finished secondary education, with an average ofapproximately 9.3 years of study, minimum 0 and maximum 20 years of study. What theprofessional situation is concerned, it was observed that 40.5% were unemployed and75.7% gained an income of less than one minimum wage .With regard to medication adherence, for this study, only consent with theantiretroviral therapy was considered, as the literature does not present any validatedtool to measure compliance with ARVT and tuberculostatic drugs at the same time amongpatients confected with HIV/TB.In When the variables sex, age, color, marital situation, education, occupation, income andnumber of people living at the same home were assessed, correlated with the adherencelevels, no statistically significant differences were observed. On the opposite,statistically significant proportional differences were obtained between sexualorientation and adherence (p=0.024) and number of children and adherence (p=0.029).When assessing the HIV/TB coinfected patients' clinical characteristics and thecorrelation with the level of adherence, it was observed that, concerning knowledge ofthe sexual partner's serum status of the 23 people whose partners took the anti-HIVtest, adherence was inappropriate in 86.9% (n=20), independently of the test result. Thethree people with appropriate adherence had a seroconcordant current sexual partner.Statistical significance was obtained for the length of use of ARVT and compliancelevels (p=0.018), but the other variables  showed no proportional similarity, as thep-values were higher than 0.05 (p≥0.05).When analyzing the forms of exposure to tuberculosis, the predominance of the pulmonaryform was demonstrated and, concerning the correlation with adherence to ARVT, nostatistically significant difference was observed (p=0.374) .(-). In Brazil, the AIDS epidemic has grown among younger individuals andwomen. As observed in other studies(-), however, the population with HIV/TB coinfection predominantly included menof economically productive age.Similar to the present findings, the HIV/TB coinfection was more frequent in individualsbetween 30 and 39 years of age, representing the economically most active part of thepopulation-11. Itudies-, howeve.Among the study variables, education is strongly associated with precarioussocioeconomic conditions. Using it as a substitute measure of poverty, this suggeststhat people with this coinfection are in a situation of impoverishment, with a reducedability to cope with the consequences of diseases due to the deficient access topreventive, diagnostic and curative services.. Concerning the form of TB, this information differs from the present studyfindings, in which pulmonary tuberculosis was the predominant clinical form in peopleliving with HIV.A significant association was reported between HIV/TB coinfection and living in an urbanarea and extrapulmonary TB. After the establishment of AIDS, it is known that theextrapulmonary forms of TB become more common. Concer.As regards the occupational situation, there are high unemployment rates amongcoinfected patients. This finding was also observed in this study, demonstrating thatthe economic and social difficulties can influence their professional possibilities,maintaining their conditions of poverty..In another study, the professional activity was mentioned as one of the most relevantfactors to cope with the condition of the HIV infection. The work environment wasappointed as a place of contact and experience exchange among people, favoring mentalcoping with the infection. In the disease situation, the availability of social supportraises the self-esteem and the desire to live, contributing to the success of theirtreatment..The participants in this study presented low T CD4+ cell counts and a high viral load,supporting the literature and indicating that TB is an opportunistic infection, stronglyassociated with the decrease of the immunological system. It is observed that, overall,people coinfected with HIV/TB present greater immune system problems when compared topeople who simply suffer from HIV infection in the asymptomatic phase..The most frequent difficulties people living with HIV/TB coinfection face are related tosocioeconomic aspects, social factors, lifestyle and difficulties with the therapeuticregimens and with the intervals between the drug doses, characterized as motives thatinterfere significantly in continuing and effective adherence.. This situation may have contributed to the predominantly inappropriatecompliance with ARVT in this study.The treatment of coinfected people tends to be difficult. TB patients need long-termtreatment with different drugs. For HIV/TB patients, compliance with the therapeuticscheme is difficult as they have to use concomitant drugs to treat bothinfections. This s.A study indicates that the variables significantly associated with non-compliance withthe double therapy were: male sex, low income, presence of three or more chronicconditions, having a knowingly HIV-positive partner and sexual relationships in theprevious three months., differently from the scientific hypothesis formulated for this study.In a study aimed at identifying the determinants of medication compliance in patientscoinfected with HIV/TB, it was demonstrated that a large number of people living at thesame home, lack of financial resources to promote self-care and deficient knowledge onthe diseases were factors that interfered in appropriate adherence to the medication.The sociodemographic variables were not considered as predictive factors that influencedmedication adherence, differ.In the assessment of the quality of life of people living with HIV/AIDS, according tothe levels of compliance with the antiretroviral drugs, it was identified that theindividuals classified and non-compliant with the treatment had worse scores on allquality of life domains, demonstrating that non-compliance with the treatment is awidespread problem, negatively affecting patients and the population ingeneral.Compliance with ARVT among the coinfected patients was inappropriate in a significantpart of patients on antiretroviral drugs. In addition, a statistically significantdifference was observed between the levels of compliance with the antiretroviral drugsand the length of use of ARVT, sexual orientation and the number of children.The data demonstrated implications related to medication adherence and double infection,whose appropriate intake of the drugs is needed to achieve better clinical and healthconditions. In addition, the consequences of the lack of compliance particularly affectthe patients' survival and can cause higher mortality rates among people living withHIV/TB coinfection.This study appoints the need to develop a specific compliance measure for peoplecoinfected with HIV/TB, thus demonstrating a limitation in the assessment of coinfectedpatients' compliance, as the analysis was restricted to compliance with ARVT only.


Purpose. To analyze in mild Alzheimer's disease (MAD) patients, GDS-4 , whether or not some psychophysical tests (PTs) support OCT macular findings in the same group of MAD patients reported previously. Methods. Twenty-three MAD patients and 28 age-matched control subjects with mean Mini Mental State Examination of 23.3 and 28.2, respectively, with no ocular disease or systemic disorders affecting vision were included. Best-corrected visual acuity (VA), contrast sensitivity (CS) , color perception (CP), and perception digital test (PDT) were tested in one eye of each patient. Results. In comparison with the controls, MAD patients presented (i) a significant decrease in VA, PDT, and CS for all spatial frequencies analyzed, especially the higher ones, and (ii) a significant increase in unspecific errors on the blue axis . In MAD patients, a wide aROC curve was plotted in all PTs. Conclusions. In MAD, CS, VA, and the tritan axis in CP were impaired. The PTs with the greatest predictive value are the higher spatial frequencies in CS and tritan unspecific errors in CP. PT abnormalities are consistent with the structural findings reported in the same MAD patients using OCT. Alzheimer's disease (AD) is a neurodegenerative disorder of the central nervous system characterized by cortical atrophy most pronounced in the medial temporal and posterior temporoparietal regions . Disturb in vivo visualization and study of retinal changes.As an extension of the central nervous system, the retina displays similarities to the brain in terms of anatomy, functionality, response to insult, and immunology –4. FurthThe first histopathologic evidence of postmortem retinal changes from AD patients was reported by Hinton et al., who found a significant axonal degeneration in the optic head nerve . FurtherCurrently it is thought that RGC loss in AD might result from amyloid pathology in the retina. Both amyloid-beta plaques and oligomers have been reported in the human retina , 20–25. In addition to the anatomical findings in AD patients, this disease can exert an impact on most aspects of visual processing, such as visual field abnormalities –29, coloThe M visual pathway appears to be particularly vulnerable to degeneration in AD . Thus, dPsychophysical investigations of CS in AD patients have rendered results consistent with the neuropathological evidence. However, studies of CS in patients with AD have yielded variable results. Some studies have reported no AD-related deficits in spatial CS , 41, whiOCT macular studies in AD by our group and others have recently reported that mild AD (MAD) patients with a high mean score (23.3 ± 3.1) on the Mini Mental State Examination (MMSE) had significantly reduced macular nerve fiber layer thickness with or without significant peripapillary involvement , 43, 44.To select patients, we reviewed the Database of the Memory Unit of the Hospital Clínico San Carlos in Madrid (Spain), consisting of a total of 2635 patients. First, we excluded the patients with a Global Deterioration Scale (GDS) over 4  and thenThe clinical evaluation of our MAD included a review of the medical records, a caregiver interview, physical and neurological examinations, a psychometric test, neuroimaging techniques, and routine laboratory testing for dementia.For the ophthalmological part of the study only one eye of each patient was analyzed. All participants met the following inclusion criteria: being free of ocular disease, AREDS Clinical Lens Standards <2, retinal drusen and systemic disorders affecting vision, having a best-corrected VA of 20/40, having a ±5 spherocylindrical refractive error, and having intraocular pressure of less than 20 mmHg. For screening, all AD patients and control subjects underwent a complete ophthalmologic examination, including assessment of VA, refraction, anterior segment biomicroscopy, applanation tonometry , CS test CSV-1000E , Roth 28-hue color test , PDT , and dilMonocular best-corrected distant VA was determined using a standard clinical Snellen eye chart. The correction was based on the subjective refraction of the subject. The patients started to read each row from the top of the Snellen eye chart and proceeded toward the bottom. This was ended when the hit rate was less than five of eight .2. The CSV-1000E was performed at 98.5 inches as recommended by the manufacturer. The nonselected eye was occluded for each measurement. The translucent chart presents four spatial frequencies: 3, 6, 12, and 18 cyc/deg. Each spatial frequency was presented on a separate row of the test. Each row presented 17 circular patches 1.5 inches in diameter. The first patch in the row had a very high contrast grating (sample patch) on the far-left side of the row. The remaining 16 patches appeared in 8 columns presented across the row. In each column, one patch presented a grating while the other patch remained blank. The patches that presented gratings decreased in contrast from left to right across the row. The patient was directed to observe the first sample patch and to look for the grating pattern in each column. While reading across the row, the patient indicated whether the grating appeared in the top patch or the bottom patch of each column. If the grating was not visible in either patch, the patient was to report that both were blank. The patient was encouraged to guess whether a grating was at least partially visible as the threshold was approached. However, the patient was cautioned that if no gratings were visible, then the response should be “both blank.” The contrast level of the last correct response was recorded as the threshold.The CS test was performed under the same conditions for all the patients and with the CSV-1000E system  and in the presence of best-corrected VA for far vision. The CSV-1000E test provides a fluorescent luminance source that retroilluminates a translucent chart and is able to monitor and autocalibrate the light level to 85 cd/mTo administer a color-vision test that did not require a naming response, we used Roth 28-hue color test , a quick and easy color arrangement test first described by Roth . Color pThe PDT, developed in 2007 , is an eP value of <0.05 was considered statistically significant.Data for the statistical analysis were introduced and processed in SPSS 19.0 . The data are reported as mean values ± SD. The differences between MAD and control eyes were analyzed using the Mann-Whitney test. Sensitivity at 90% specificity and area under the receiver operator characteristic (aROC) analysis for discriminating between healthy and MAD patients were calculated for all the psychophysical tests analyzed. The association between the tests and MMSE was evaluated by Pearson's correlation coefficient. A Demographic and clinical data for the MAD patients and control group are shown in The mean VA in MAD patients significantly decreased in comparison with the age-matched control group . VA shown = 7) were not able to report the orientation of the 18-cpd grating at the highest contrast level. Three of these 7 MAD patients were also unable to detect the 12-cpd grating at any contrast value. The analysis of CS of the MAD patients revealed a statistically significant reduction at all spatial frequencies tested  in comparison with age-matched control subjects , higher than any value found in the literature , 49–51. VA values in the present study were within normal limits for this age range. However, mean VA in MAD patients was significantly decreased in comparison with age-matched control subjects. VA values in AD patients have been controversial. Thus, several studies reported no decrease in VA in patients with Alzheimer's neurodegeneration , 52–54 wWe found that, in comparison with age-matched control subjects, CS in MAD patients was significantly reduced in all spatial frequencies, the reduction being more pronounced at higher frequencies. Specifically, at a spatial frequency of 18 cpds, MAD patients showed a 44.57% CS reduction in comparison with age-matched control. High spatial frequencies are recorded in the P cells of the retina, which are more concentrated in the macular area. Low spatial frequencies are recorded by the M cells located over the entire retina  in whichCS in AD has been analyzed for several years. Although in two studies no differences between AD and age-matched control were detected , 54, mosIn agreement with most studies on CS in AD, CS function was impaired in our cohort of early AD. However, the degree of involvement varied among spatial frequencies, the reduction being greater at the higher ones. Notably, in the studies reported in which CS was equally decreased in all spatial frequencies, AD patients were at a more advanced stage of the disease than were our MAD patients, as indicated by their lower MMSE values. There are only two studies with results consistent with ours, showing an increased decline at the higher spatial frequencies. However, both studies presented methodological differences with respect to ours. In the Neargarder et al. study , the resThe fact that CS is impaired in AD patients in comparison with healthy elderly subjects has significant implications for cognitive abilities and daily function of AD patients , especiaWhen assessing color perception in our MAD patients, we found no significant differences in terms of color defects in comparison with age-matched control subjects. However, we found that our MAD patients made significantly more (72.62%) unspecific errors in the tritan (blue) axis than did the controls, which represented almost a threefold increase in the errors committed by the MAD group.Unlike subjects with a loss of color vision due to focal cortical lesions, patients with AD rarely complain of color-vision deficits. Color testing in patients with AD is controversial because these patients have a deficit in naming colors and therefore might have trouble verbalizing the colors or nominating numbers and shapes that are being viewed. The color test used in the present study does not require naming, although it should be taken into account that test performance depends on the memory of the patients and therefore, for appropriate testing, the instructions need to be repeated by the examiner during test session, when necessary.Some studies using the Farnsworth and Ishihara tests have found no color perception differences between patients with AD and the control group , 64, 65.Salamone et al. postulated that the problem of color discrimination in patients with AD is not purely cognitive but seems to be related to damage in the structures responsible for the perception of color stimuli . This stThe MAD patients of the present study made significantly more mistakes in PDT answers than did the age-matched control subjects. Given that no statistically significant differences in educational level were found among groups, the influence of this variable could be ruled out.P < 0.01) provided by the application of the PDT, we postulate PDT as a useful ancillary screening test for MAD.The part of the brain initially involved in AD is the temporal cortex, which is then followed by the temporoparietal association cortex , 71. As To the best of our knowledge, no predictive (ROC) analysis is available for the diagnosis value of different visual psychophysical test in AD. A noteworthy finding of the present work was that the test with the greatest prognostic value in MAD patients was CS for 18-cpd and 12-cpd spatial frequencies , followed by VA (aROC 0.771), PDT (aROC 0.758), and unspecific errors in the blue region (aROC 0.714).r = 0.536), followed by the CS for 6-cpd (r = 0.516) and 18-cpd (r = 0.468) spatial frequencies, and VA (r = 0.457) and CS for 12-cpd (r = 0.451) and 3-cpd (r = 0.366) spatial frequencies. A negative correlation was also found between MMSE and the unspecific errors in the tritan region (r = −0329). All these findings showed that as the disease progresses, the answers to different tests used for assessing visual skills worsened.As mentioned above, our AD patients had a high mean MMSE value, the highest so far reported to the best of our knowledge. However, given that MMSE values ranged from 17 to 31, we investigated whether the MMSE value influences the test outcome. As a result, we found a significant correlation between MMSE values and PDT , and the early stage of disease . Another limitation could be the sample size. Gathering large samples is a difficult task when dealing with MAD patients. This was especially true in the present study in which the inclusion criteria were very demanding in order to recruit patients in early stages of AD who were also free of ocular pathology, the latter requisite limiting patient enrollment given the age range of the sample. Nevertheless, our sample size was comparable to that reported in the literature , 51, 59.In conclusion, our study demonstrates a deficit in visual perception in early stages of AD, manifested by reductions in VA, CS, and color discrimination. These psychophysical changes correlate with retinal morphological changes (decreased RNFL macular thickness as detected by OCT) detected in the same group of patients . Further


Audiovisual speech perception of children with specific language impairment (SLI) and children with typical language development (TLD) was compared in two experiments using /aCa/ syllables presented in the context of a masking release paradigm. Children had to repeat syllables presented in auditory alone, visual alone (speechreading), audiovisual congruent and incongruent (McGurk) conditions. Stimuli were masked by either stationary (ST) or amplitude modulated (AM) noise. Although children with SLI were less accurate in auditory and audiovisual speech perception, they showed similar auditory masking release effect than children with TLD. Children with SLI also had less correct responses in speechreading than children with TLD, indicating impairment in phonemic processing of visual speech information. In response to McGurk stimuli, children with TLD showed more fusions in AM noise than in ST noise, a consequence of the auditory masking release effect and of the influence of visual information. Children with SLI did not show this effect systematically, suggesting they were less influenced by visual speech. However, when the visual cues were easily identified, the profile of responses to McGurk stimuli was similar in both groups, suggesting that children with SLI do not suffer from an impairment of audiovisual integration. An analysis of percent of information transmitted revealed a deficit in the children with SLI, particularly for the place of articulation feature. Taken together, the data support the hypothesis of an intact peripheral processing of auditory speech information, coupled with a supra modal deficit of phonemic categorization in children with SLI. Clinical implications are discussed. Children with specific language impairment (SLI) experience difficulties in understanding and producing spoken language, despite normal intelligence, normal hearing, and normal opportunities to learn language. Although linguistic deficits fundamentally characterize SLI  compared to stationary noise  and lipreading (VO stimuli) performances, as well as audio-visual speech perception (AV congruent stimuli) were also measured. In AO, we expected a larger speech-in-noise deficit in children with SLI compared to TLD children, but a similar masking release effect in both groups . The stimuli were presented in Audio-only (AO), Visual Only (VO), and Audio-visual (AV) congruent and AV incongruent conditions.In Experiment 2, larger groups of children with SLI and children with TLD were recruited. Twelve consonants (six voiceless and six voiced) masked either by stationary or by amplitude modulated noise (at 8 Hz) noise were presented in AO, VO, AV congruent conditions, and four McGurk stimuli  were used. The first aim of Experiment 2 was to replicate the results of Experiment 1 with a large set of consonants. The second aim was to evaluate the specific reception of voicing, place and manner by information transmission (IT) analyses performed on the basis of confusion matrices . All children had measured reading and spelling levels corresponding at least to the end of first grade.Fifteen French-speaking children with SLI (8 boys) were recruited in special language classes and through an association of parents of children with SLI. The participants met the following criteria: (1) presence of a long-lasting and severe impairment of expressive and/or receptive language, diagnosed as SLI by a neuro-pediatrician in a multi-diciplinary team; (2) no history of hearing loss and no malformation of speech organs; (3) a score > 132 points on the pragmatic component  of the Children's Communication Checklist Bishop, ; (4) a nLanguage assessment tests included: (a) reading aloud of pseudowords and phonically regular and irregular frequent words of the Odedys Test  ranging in age from 9 years 1 months to 14 years 6 months . The scores of the children with TLD were within normal limits for the three language tests.The characteristics of the participants and a summary of the language test scores of the children with SLI and those with TLD are found in Table The project has been reviewed and approved by the University research ethic board. Informed consent was obtained from the parents of all participants, and children provided a verbal acceptance prior to their participation. They were informed that they could interrupt their participation if they felt any problem during the experiment.Stimuli were composed of vowel-consonant-vowel (VCV) syllables with the consonants /p, t, k, s, f, ∫/ interposed between two /a/ vowels. A male speaker of French was videotaped while saying these syllables. He was filmed from the bottom of the nose to the chin. The production of each stimulus began and ended in a neutral position, with the mouth closed. Videos  were displayed centered on a 15-inch MacBook Pro laptop on a black background. Three productions of each /aCa/ stimulus were digitally recorded and audio tracks were equalized in level. Eighteen stimuli (six syllabes × three repetitions) were used to create the AV, AO and VO trials. Stimuli were delivered through Sennheinser HD 121 Pro headphones.The congruent AV stimuli included digital audio-video files of the speaker saying and articulating the /aCa/ stimuli. For the AO condition, an image of the speaker, appearing neutral and with mouth closed was presented along with the auditory stimulus. For the VO condition, the audio was turned off. Finally, incongruent AV McGurk stimuli were created by carefully combining audio files with non-corresponding video files and matching their onset. We used three repetitions of the two following stimuli: audio /apa/ with visual /aka/ (fusion /ata/) and audio /afa/ with visual /a∫a/ (fusion /asa/).The total number of items was 180 stimuli . Four blocks of 45 items were constructed. In each block, the order of appearance of the stimuli was fixed and identical for all participants.Auditory noise. Each signal was digitalized at a 22,050 Hz sampling frequency. Throughout all conditions of the experiment, stimuli were embedded in noise which was either stationary , either modulated in amplitude. Modulation in amplitude was achieved by using a white Gaussian noise low-pass filtered at 500 Hz (WGNf). The expression describing the sine-wave modulator, m(t), wasfm was 8 and 128 Hz. The noise was then added to the signal. The SNR was fixed at −23 dB (prior to the 500 Hz filtering). This SNR was determined in a preliminary experiment so as to yield a consonant identification performance of about 40% correct under stationary noise (in AO condition).The experiment was conducted in a dimly-lit quiet room. Participants were seated in front of the laptop and fitted with headphones. Stimuli were presented on a monitor positioned at eye level, 70 cm from the participant's head. Participants were given verbal and written instructions to watch the computer monitor and listen for speech sounds that would be heard over headphones. They were informed about the identity of the six syllables that would be presented. They were instructed that for some trials, there would be a speech sound but the face would not move , sometimes the face would move but there would be no speech sound (the VO stimuli) and sometimes there is a speech sound and a moving face . No information was given about the presence of the McGurk incongruent stimuli.La planète des Alphas, Huguenin and Dubois, Participants were instructed to designate a letter corresponding to the consonant they thought the speaker had said. The six letters were taken from a speech therapist kit . In a second session, they were submitted to the three language tests.Participant's percent-correct identification of the VCV syllables presented in each of these conditions served as the dependent measure. For McGurk stimuli, the percent responses corresponding to Audio, Visual and Fusion responses were recorded.The experiment took place in two 30 min sessions. The first session was devoted to the collection of language measures, and the second one to the experimental data. The experimenter was careful about the attention and concentration of the children, and proposed breaks if necessary.Results in noise modulated at 8 Hz and noise modulate at 128 Hz were averaged for more clarity and because they were not significantly different.First, results were analyzed in the AO modality in order to ascertain whether our experimental design generated a masking release effect, i.e., higher performances in AM noise than in ST noise. The percentage of correct identification of children with SLI and with TLD for quiet, AM noise, and ST noise, and the masking release effect are presented in Table F = 327.94, p < 0.001], and of Group, . The Group × Noise interaction was not significant. Orthogonal contrasts were made on the effect of Noise. The first contrast, comparing the results in quiet on the one hand, and in AM and ST Noise on the other hand, was highly significant, . The second contrast, comparing the results in AM noise and ST noise, was highly significant too, . None of these contrasts interacted with the Group effect. To sum up, performance was better in modulated noise than in stationary noise, and better in quiet than in noisy conditions. The 4.4% difference of masking release between children with SLI and TLD was not significant.An ANOVA with repeated measures on Noise  and Group  was run on these data. The analysis yielded a significant effect of Noise, . Neither the Effect of Noise, nor the Group × Noise interactions were significant. To sum up, children with SLI achieved lower performance in identification of syllables presented in speechreading; as expected, auditory noise had no significant effect on the performance in VO.Second, results were analyzed in the VO modality. As expected, children with TDL achieved better performances in VO than children with SLI, regardless of whether the stimuli were presented in quiet, in AM noise, or in ST noise  = 31.58, p < 0.001], and of Group, . The Group × Noise interaction was not significant. Orthogonal contrasts were made on the effect of Noise. The first contrast, comparing the results in quiet on the one hand, and in AM and ST Noise on the other hand, was highly significant, . The second contrast, comparing the results in AM noise and ST noise, was highly significant too, . None of these contrasts interacted with the Group effect.A repeated measures ANOVA with Noise  as within-subjects factor and Group  as between-subjects factor was run on these data. The analysis yielded significant effects of Noise, , a higher number of fusion responses , and significantly less visually responses  in AM noise.In ST noise, children with TLD mainly gave a low rate of auditory responses , and fusion responses , and a high rate of visual responses . Compared to ST noise, children with TLD gave significantly more auditory responses  than in ST noise. The percent of fusion responses  and of visual responses  was not significantly different from that in ST noise.In ST noise, children with SLI gave 13.0% (SD: 18.7) of auditory responses, 22.5% (SD: 14.0) of fusion responses, and 48.9% (SD: 23.2) of visual responses. In AM noise, they gave more auditory responses , but their rate of fusions  and visual responses  remained unchanged.In ST noise, children with SLI gave 6.2% (SD: 12.4%) of auditory responses, 18.5% (SD: 24.6%) of fusions, and 37.6% (SD: 31.6%) of visual responses. Compared to ST noise, their auditory responses increased in AM noise, , and a larger number of fusion ; their rate of visual responses significantly decreased .F = 9.66; p < 0.005], and fusion responses ; their rate of visual response significantly decreased .In ST noise, children with SLI gave 9.3% (SD: 14.1%) of auditory responses, 19.5% (SD: 17.9%) of fusions, and 54.9% of visual responses (SD: 26.5%). Compared to ST noise, they gave significantly more auditory [27.2%; SD: 28.3%; F = 7.93; p < 0.01 and F = 7.88, p < 0.01 respectively, and less fusions in AM noise, F = 15.42, p < 0.001. No difference appeared for visual responses.Compared to children with TLD, children with SLI gave more auditory responses in ST and AM noise, Finally, in quiet, there was no difference between children with SLI and children with TLD for any kind of response  analyses performed on the basis of the individual confusion matrices. The percent of IT was averaged over quiet, ST noise and AM noise, and displayed in Figure F = 111.41 p < 0.001, of Modality, F = 925.33, p < 0.001, and of Group, F = 35.15, p < 0.001. The Modality × Features interaction was significant, F = 102.22, p < 0.001: IT increases from AO to AV was 17.4% for place, 14.9% for manner, and 8.7% for voicing. No other interaction was significant.Because IT was very different in AO or AV than in VO, two separate analyses were run. A repeated measures ANOVA with Feature  and Modality  as within subjects factor, and Group as between subjects factor yielded significant effects of features, F = 190.86, p < 0.001, and of Group, F = 11.58, p < 0.001. The Group by Feature interaction was also significant, F = 9.42, p < 0.001: the difference between groups was large for place of articulation (12.0%), intermediate for manner (6.6%) and almost null for voicing (1.7%).The percent of IT in VO was analyzed with a repeated measures ANOVA with Features  as within subjects factor, and Group as between subjects factor. The analysis yielded a significant effect of Features, In Experiment 2, new groups of children with SLI and children with TLD matched as closely as possible for gender, chronological age and non-verbal intelligence were tested with an audio-visual masking release paradigm. The identification of syllables in noise was clearly more difficult in Experiment 2 than in Experiment 1. Two reasons may be invoked. A more extensive protocol consisting of voiced and voiceless syllables was administered, and the voiced syllables were more difficult to identify than the voiceless ones. In addition, children with SLI of Experiment 2 could be more language impaired than those of Experiment 1, as indicated by their lower scores on the Word Repetition test.Despite these differences, the main results of Experiment 2 remarkably replicated the findings of Experiment 1. Children with SLI showed a speech-in-noise deficit, but a masking release effect comparable in size to that of children with TLD. A clear speechreading deficit appeared in children with SLI compared to TLD children. Children with SLI also had less accurate audio-visual speech perception than TLD children. With no surprise, the standardized visual gains of children with SLI were lower than those of TLD children, coherently with the tendency observed in Experiment 1  is useful to better understand the dynamics of speech perception. A significant increase of percent of IT in AV compared to AO was observed for place of articulation and manner in both groups of children. The complementarity between auditory and visual information is maximal for place of articulation. The fricatives /aӡa/ and /a∫a/, which are highly visible, contribute to the improvement of visual transmission of both manner and place of articulation. Surprisingly, the perception of voicing was improved in AV although voicing was not transmitted by speechreading itself, as indicated by the 50% of IT in the VO modality. It is possible that seeing the movement of the articulators enhances children's attention to the coming sound.Interestingly, children with SLI showed lower IT percent than children with TLD in the three modalities. This demonstrates that their deficit of IT already found in AO , as well as with V/asa/ and /aza/ (17% in TLD and 19% in SLI). Therefore, the visual information transmitted is reduced and the percent of visual responses is low for both groups. When more auditory information became available, TLD children showed an increase of fusions. SLI children did not but increased their rate of auditory responses.In the case of fricatives A/afa/V/a∫a/ and A/ava/V/aӡa/, the visual information is easily identified: 84% in TLD and 65% in SLI children. Both groups showed a large amount of visual responses in ST noise (62% for TLD and 55% for SLI children), which significantly decreased in AM noise (18% in TLD and 21% in SLI children). Both groups also showed an increase of auditory and fusion responses in AM, when more auditory was available. The data thus suggest that when children with SLI get access to visual information, they are able to integrate it with auditory information. In other words, the pattern of responses of SLI children is the result of their poorer lipreading skills, but not of a deficit in AV integration. Taken together, the data illustrate the interest of using two types of McGurk stimuli, varying by the degree of availability of the visual information  difficulty for children with SLI in discriminating /aCa/ syllables under optimal listening conditions. These data confirm previous studies testing AO . Again, this result dismisses the idea that the speech perception deficit of children with SLI has a purely auditory basis. Should that be the case, the deficit in the auditory processing domain could be partially circumvented by reliance on visual speech.The speechreading deficit of SLI children also impacts their response pattern to McGurk stimuli. As expected, TLD children gave mainly visual responses in ST noise, and significantly more auditory and fusions responses in AM noise. In other words, TLD children exhibited a release from masking of the McGurk fusions , children with SLI seem able to integrate auditory and visual information adequately, even if they showed less influence of visual speech. This result is compatible with the “deficit in speechreading skills” hypothesis. On the other hand, it may be that the visual articulatory gestures are processed more independently of the auditory information for children with SLI than for children with TLD. Green  suggesteThe data obtained by children with SLI contrast with those obtained by children with cochlear implant assessed with a similar paradigm (Huyse et al., There are several limitations to the present studies. Children with SLI are a heterogeneous group. It would be interesting to examine whether their speechreading ability and use of visual cues to improve audiovisual speech perception is also variable. Do they differ in linguistic processing of visible articulatory gestures, or do they differ in attentional processes ? Is there a relation between impairment in visible speech processing and potential temporal processing deficits in SLI (see Ten Oever et al., In addition, the deficit in speech-in-noise perception, poor perception of visual speech, difficulties in fusing auditory and visual stimuli in classic McGurk stimuli could be related to cortical and sub-cortical responses in future studies. According to Hornickel et al. , abnormaWe can only speculate as to whether or not language training may modify the ability of children with SLI to process the visual speech cues. A long-term study on how speech and language remediation training can help children with SLI more effectively utilize visual articulatory cues in identifying impoverished speech elements may help address this issue better. It would also be interesting to investigate whether their reduced ability to combine auditory and visual information is speech specific, or also occur for other types of integration auditory and visual non-speech, or audio-tactile information. This issue is at the agenda for future research. The outcomes of these types of research will help to better understand the causes of reduced audio-visual speech integration in children with SLI, and to design more adapted rehabilitation programs.The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.


Canis aureus occurs in south-eastern Europe, Asia, the Middle East, the Caucasus, and Africa. In Serbia, jackals neared extinction; however, during the last 30 years, the species started to spread quickly and to increase in number. Few studies in the past have revealed their potential role as carriers of zoonotic diseases. Animal samples were collected over a three-year period (01/2010–02/2013) from 12 sites all over Serbia. Of the tissue samples collected, spleen was chosen as the tissue to proceed; all samples were tested for Leishmania species and Brucella species by real-time PCR. Of the 216 samples collected, 15 (6.9%) were positive for Leishmania species, while four (1.9%) were positive for B. canis. The potential epidemiologic role of the golden jackal in carrying and dispersing zoonotic diseases in Serbia should be taken under consideration when applying surveillance monitoring schemes.The golden jackal  Canis aureus occurs in south-eastern Europe, Asia, the Middle East, the Caucasus, and Africa [The golden jackald Africa , 2. Durid Africa . Currentd Africa  making iIn Serbia, jackals neared extinction due to extensive poisonings organized after World War II, initially aimed at controlling the size of the wolf population and lessening the damage they caused to domestic animals. Only two relic populations survived in Srem and in eastern Serbia near Bulgarian borders , 6. At tThe golden jackal is described as an opportunistic species, capable of using a wide range of food sources . StudiesIncreasing densities and widening of its European populations have not been accompanied by research of the presence of pathogens of interest both to animals and to humans. Only few studies have evaluated the potential of jackals as carriers of zoonotic diseases in Europe, while none has been conducted so far in the Serbian territory. Brucella species and Leishmania species in the jackal population in Serbia and to evaluate its importance for animals and human health.The scope of the current survey was to study the presence of two zoonotic agents,Animal samples were collected over a three-year period (01/2010–02/2013) from 12 sites  all over the country , in coopSampling took place from dead animals brought at the Laboratory for animal ecology  by hunters. Data regarding location, sex, and date (of death) of each jackal were recorded. At necropsy, samples from different tissues were collected  and stored at −80°C until further processing.Of the tissue samples collected, spleen was chosen as the tissue to proceed with the testing, based on the increased possibility, among the tissues collected, to detect the pathogens of interest. Tissue samples were processed by homogenizing frozen pieces of spleen using micropastles. A small portion of smashed tissue was then removed and processed using the Gene Jet Genomic DNA Purification Kit . All DNA extracts were stored at −20°C until PCR analysis.μL. In case a positive PCR was detected, we went back to each pool and tested each corresponding DNA extract seperately.Real-time PCR assays were carried at the Laboratory of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine of the University of Crete (Greece), where part of the DNA extracts was brought and always stored at −20°C. DNA extracts were initially pooled, at pools of five, at a final volume of 20  Brucella species, a multiplex real-time PCR protocol was used, targeting the bcsp31, alkB, and BMEI1162 genes of Brucella species, B. abortus, and B. melitensis, respectively, as previously described [ B. canis was tested using a PCR protocol targeting the omp2B gene as previously described [For the detection ofescribed . Where iescribed . Leishmania species a real-time PCR protocol targeting the SSU rRNA gene was used, as previously described [For the detection ofescribed .μL, 10 μL of SsoFast Probes Supermix was used as a mastermix together with 0.6 μL (in the case of Brucella species) or 1.6 μL (in the case of Leishmania species) of each primer (10 μM), 0.4 μL (in the case of Brucella species) or 0.2 μL (in the case of Leishmania species) of each of the probes (10 μM), 2.7 μL (in the case of Brucella species) or 4.1 μL (in the case of Leishmania species) of sterile water, and 2.5 μL of the corresponding DNA. Brucella melitensis and Leishmania infantum isolated from human patients were used as positive controls for the corresponding assays. Two sets of negative controls (DNA from noninfected specimens and sterile water) were applied.All real-time PCR assays were carried out on a C1000 Touch, CFX96 thermal cycler (Biorad). At a final volume of 20  P value < 0.05 was considered as significant.Chi-square (SPSS v. 19) was applied to compare results in-between gender and among sampling years. In all cases aA total of 216 spleen samples, collected from 48 localities corresponding to 12 sites of Serbia , were te Leishmania species, while four (1.9%)  were positive for B. canis. A single pool of those initially tested was also positive for Brucella species; however, when we went back to test each corresponding DNA extract separately we could not trace which was the positive one, perhaps due to very low initial DNA concentration. In that single case, we went back to the original tissues, collected multiple samples from each tissue, and performed individual PCR amplifications always, however, getting negative results. None of the samples which tested positive for Brucella species was positive for B. abortus or B. melitensis.Of the 216 samples, 15 (6.9%)  were positive for Leishmania species and for B. canis. Although the number of samples did not fluctuate dramatically from 2011 to 2013, a remarkable increase in the number of positive samples recorded for Leishmania species (P = 0.011), but not for B. canis (P = 0.436), was recorded during 2013. As regards the distribution over the various regions, it was noted that the higher the number of samples collected from a certain region, the higher the possibility to retrieve a positive sample. Concerning gender, Leishmania species showed a preference to males over females (P = 0.061), contrary to the results for B. canis (P = 0.313).As expected, based on the distribution of the collected samples throughout the year, all positive samples were recorded during the winter (hunting period) both forAll results are summarized in detail in Wildlife is considered as playing a crucial role in the maintenance and dispersal of leishmanioses and reservoirs may include rodents, marsupials, edentates, monkeys, domestic dogs, and wild canids . Ehrlichia canis [ Leishmania donovani [ Echinococcus granulosus [Jackals are known to be omnivores and scavengers and they usually prey on small mammals but on vegetables, fruit, and garbage as well. Their ability to adapt to novel habitats both on rural and urban areas allows them to come into contact with animals that live in close proximity to humans, such as dogs, hence their ability to host a number of zoonotic pathogens, such as canine viruses , Ehrlichia canis , Leishmadonovani , 24, andanulosus , as wellAccording to ECCMID, visceral leishmaniasis is endemic, amongst other countries, in Serbia as well . In fact Leishmania species in jackals.In a study recently conducted in Hungary in sera collected from jackals, no evidence for the presence of leishmaniasis was noted . To our  L. infantum in Algeria [ L. infantum in wildlife , recording a seroprevalence of 7.6%, which, taking into account the presence of the pathogen in dogs from the same regions, led the public authorities to raise suspicions on the possible role of wildlife in spreading this disease [ L. tropica being added to the species of Leishmania that jackals can host; results of both studies resembled the ones we came up with (6.9%).Away from the European territory, there have been reports that described the presence in jackals of these agents, such as visceral leishmaniasis  in Israe Algeria . In fact disease . In a la disease , while i disease , a preva L. infantum has been reported in golden jackals in Iraq [Getting further away from Europe, the presence of in Iraq  and in K in Iraq , while i in Iraq –37.As far as Brucellosis is concerned, Serbia is considered as a country with relatively low numbers of incidence rate (0.15/100.000) amongst the rest of Balkan countries and with a relatively low incidence rate within the European Union . Neverth Brucella species have been identified in wild boar in France and Italy, in brown hare in Austria, France, the Czech Republic, and Switzerland, and in chamois and red deer in the Alps. Recently, its presence was also recorded in free-roaming domestic pigs, an indication that perhaps a wild reservoir may act as a source of the agent [ Brucella in sheep and springbok [ Brucella, and this observation was attributed to the role of jackals and other carnivores in removing aborted fetuses and feeding on fetal membranes. During the late 60s, some evidence was recorded on the presence of Brucella species in jackals, in a study conducted in Tanzania [ Brucella species; nevertheless, their tendency to scavenge carcasses and perhaps share areas of grazing with animals of veterinary importance may not exclude them as a potential source of dispersal of the pathogen.In Europe,he agent . As regapringbok  it was sTanzania . The relAn increase in jackal population has lately been observed in Serbia , while cIn any case, further study is required to discern the potential epidemiologic role of the golden jackal in spreading and transmitting the above studied pathogens not only within Serbia but to neighbor countries as well; local awareness of residents, veterinarians, and health professionals would prove of great importance in order to efficiently monitor these and other zoonotic diseases. Leishmania and Brucella species in Serbia. Its growing population and its capacity to spread and interfere with regions of animals of veterinary importance and/or of humans should point out a hint on future surveillance schemes on these two pathogens.The golden jackal is a carrier of a number of zoonotic diseases as has been recorded in the past. Herein we described the potential role of the golden jackal as a carrier of


We developed a standardised method to assess the quality of infection control in Dutch Nursing Home (NH), based on a cross-sectional survey that visualises the results. The method was called the Infection control RIsk Infection Scan (IRIS). We tested the applicability of this new tool in a multicentre surveillance executed June and July 2012.Enterobacteriaceae (ESBL-E); two patient-related risk factors, i.e. use of medical devices, and antimicrobial therapy; and three ward-related risk factors, i.e. environmental contamination, availability of local guidelines, and shortcomings in infection prevention preconditions. Results were categorised as low-, intermediate- and high risk, presented in an easy-to-read graphic risk spider-plot. This plot was given as feedback to management and healthcare workers of the NH.The IRIS includes two patient outcome-variables, i.e. the prevalence of healthcare associated infections (HAI) and rectal carriage of Extended-Spectrum Beta-Lactamase (ESBL) producing Large differences were found among most the variables in the different NH. Common shortcomings were the availability of infection control guidelines and the level of environmental cleaning. Most striking differences were observed in the prevalence of ESBL carriage, ranged from zero to 20.6% (p < 0.001).The IRIS provided a rapid and easy to understand assessment of the infection control situation of the participating NH. The results can be used to improve the quality of infection control based on the specific needs of a NH but needs further validation in future studies. Repeated measurement can determine the effectiveness of the interventions. This makes the IRIS a useful tool for quality systems. Healthcare associated infections (HAI) constitute a major public health problem,2. Due tStaphylococcus aureus, yearly consumption of antiseptic hand-wash products and an index of activities for fighting against HAI.To determine the prevalence of- and risk factors for HAI and resistant microorganisms, prevalence surveys are common tools in hospitals and in NH. These surveys typically only include patient-related variables, such as, gender, age, use of medical devices or antimicrobial use-8. HowevSurveillance is the basis for quality improvement although performing surveillance itself does not result in a change. HoweverTherefore, we developed a tool to provide a standardized and holistic assessment of the quality of infection control in Dutch NH based on a cross-sectional survey. The data were visualised in an easy to read spider plot. We tested the applicability of this new tool in a multicentre study.The IRIS was developed to provide a standardized and holistic measurement of the quality of infection control in health care centres. The data were presented in an easy to read spider plot. The IRIS consists of a cross-sectional surveillance and investigates 2 outcome variables, 2 resident-related risk factors and 3 ward-related risk factors: prevalence of HAI, prevalence of rectal carriage of ESBL producing Enterobacteriacea (ESBL-E), prevalence of medical device, prevalence of antimicrobial therapy, Environmental contamination, shortcomings in infection prevention preconditions and availability of local infection prevention guidelines. The selection of the 5 risk factors was based on the importance, as judged by a group of experienced infection control practitioners, as well as the possibility of an objective and reproducible assessment.The IRIS was performed in 9 NH in the southern part of the Netherlands belonging to one governing organization. Facilities with residents with somatic-, psychosomatic and/or an indication for rehabilitation were included in the survey. The IRIS was performed in June and July 2012.Two trained infection control practitioners (ICP), collected the data using standardised electronic case record forms. One of the attending NH physicians assisted with the surveillance for HAI, use of medical devices and antimicrobial use. By discussing all (possible) HAI with the NH physician and the other ICP, the results were validated.The institutional infection control committee and the board of directors of the NH approved the performance of the IRIS. As non-invasive samples were taken and the data was analysed in an anonymous way, informed consent was waived. Participation in the study was voluntary.For each outcome variable or risk factor, breakpoints were set to make the division in 3 categories; low, intermediate and high. The breakpoints, for the classification in low, intermediate and high, are based on national prevalence surveys, scientific publications and if no data was available on expert opinion  area, in-depth research and/or improvement activities were recommended, e.g. as antimicrobial use or use of medical devices are situated in the high risk area, the appropriateness of the indication is investigated and reported as well.Population characteristics, which cannot be influenced by HCW activity, are also investigated and used as background information to adjust the interpretation of the risk plot. If the population was classified as high-risk, in-depth research and/or improvement activities were already recommended when results were situated in the intermediate (risk) area. So the interpretation of the spider-plot was partially dependent of the risk profile of the population.All residents present in the NH, on the day of the survey, with a duration of stay in the facility of at least 24 hours, were included. The following population characteristics were assessed: age, gender, admission indication, multimorbidity, pressure ulcer sores and intensity of care needed ,15. MultThe presence of HAI, sepsis/bacteraemia, lower respiratory tract infections, urinary tract infections, gastrointestinal infections or bacterial conjunctivitis, was detThe breakpoints, for the classification in low, intermediate and high, of HAI were based on data from the Dutch prevalence surveys for NH,7,9.Rectal carriage of ESBL-E was determined by culture of perianal swabs  or faeces. Swabs (or faeces) were placed in a tryptic soy broth, containing vancomycin (8 mg/L) and cefotaxime (0.25 mg/L) (TSB-VC). After overnight incubation the TSB-VC was subcultured on an EbSA screening agar plate , and incubated aerobically overnight. The EbSSpecies identification and susceptibility testing was performed for all isolates that grew on either side of the agar using MALDI-TOF MS and VITEK 2  respectively. For suspected isolates (MIC ceftazidime and/or MIC cefotaxime > 1 mg/L) the presence of ESBL was phenotypically confirmed with the combination disk diffusion method , according to the Dutch guideline for the detection of ESBL-E. GenotypReference data on rectal carriage of ESBL-E in NH in the Netherlands are not yet available. This complicates the classification of categories low, intermediate and high). Prevalence of rectal ESBL carriage in 2010/2011 in a large teaching hospital in the same geographical region varied from 4 to 6% with a high variability of the genotypes, indicating that cross transmission is rare with a background prevalence in the population of around 7%. Risk caResident-, ward- and institution-related risk factors were investigated.1. Use of medical devicesThe presence of medical devices, such as indwelling urethral or suprapubic catheters, intravascular devices, a tracheostomy, a Percutaneous Endoscopic Gastrostomy tube (PEG), gastric tube or Anus Preaternaturalis (AP) stoma, on the day of survey, was registered. The breakpoints, for the classification in low, intermediate and high, of prevalence of medical devices were based on data from the Dutch prevalence surveys for NH,7,9.2. Use of antimicrobial therapyThe use of systemic antimicrobial therapy, on the day of survey, was recorded. AntivirThe breakpoints, for the classification in low, intermediate and high, of prevalence antimicrobial use were based on data from the Dutch prevalence surveys for NH,7.3. Environmental contaminationDetection of Adenosine Triphosphate (ATP) was used to identify the level of environmental contamination with organic material. The ATP samples were taken using an ATP device  after the routine cleaning in the morning. Samples were taken from 10 pre-defined objects or surfaces within each ward, according to the protocol of the manufacturer . Demographic characteristics are shown in Table A total of 59 (7.6%) residents had at least one medical device present on the day of the survey (ranging from 0% up to 12.1% in the different NH). The highest prevalence of medical devices was observed in the NH with a high proportion (20%) of rehabilitation residents. The most prevalent medical device was a urethral catheter (n = 42), next a suprapubic catheter (n = 9), a PEG (n = 7), a tracheostoma (n = 4), one peripheral intravascular catheter and two others.p = 0.002).There was no significant difference in the prevalence of HAI between the NH  residents were treated with antimicrobials on the day of the prevalence survey. Nitrofurantoin and amoxicillin/clavulanic acid were most frequently used . Eighteen residents  were treated with antibiotics while no HAI was registered. The indications for antimicrobial use were skin infection (n = 5), respiratory infections (n = 2), surgical site infection already present on admission (n = 2), prophylaxis (n = 9), which include maintenance dose for recurrent urinary tract infections (n = 6), when changing a catheter (n = 1), maintenance dose for COPD (n = 1) and unknown (n = 1). Differences of antimicrobial use in the NH were observed (range 0% - 9.2%). NH 9 had a significantly lower prevalence of antimicrobial use than the average use in the other NH . Infection control preconditions were missing in all NH: overall 18% with a range from 5% in NH 2 to 40% in NH 8. In all but 2 wards, hand alcohol was available. Most frequently observed shortcomings were the absence of protective gowns and the absence of at least one hand washing facility per 15 residents.Environmental contamination was high in all but one NH (NH7). Heavily contaminated surfaces were most frequently found on the bedside commode (58/59 = 98.3%), kitchen/microwave (34/56 = 60.7%) and toilet seat (36/62 = 58.0%).The surveillance could be completed in about 2 hours per department (approximately 20 residents). Validation, analyses, preparation of feedback data and visualisation took another 2 hours. The total time investment for performing an IRIS in these 9 NH (774 residents) was 20 days.All surveillance data and plots were presented to-, and discussed with management of the governing organisation. Subsequently every IRIS plot was presented to management and healthcare workers of the involved institute. The message was well received by management and an extensive improvement program was initiated; infection preconditions were resolved, missing guidelines were developed and implemented and an education program has started. The NH with the high prevalence of ESBL-E carriage informed the inspectorate for healthcare about the findings and initiated and outbreak management team to contain the spread of the outbreak strain.E. coli ST131, a well-known epidemic clone associated with health care facilities, was found[The IRIS showed a large variation in outcome variables and risk factors among the 9 participating NH. The management of the NH used the information to initiate targeted improvements of the infection control situation. The common shortcomings were the availability of infection control guidelines and the level of environmental cleaning. The most striking differences were found in the prevalence of ESBL. The extremely high ESBL carriage rates in some NHs deserve further investigations. In NH 9, extensive clonal spread of as found. These ras found. We delias found. There iThere were no significant differences between prevalence of HAI and antibiotic use between the individual NH, except for one outliner regarding antimicrobial use. More research is needed to investigate the appropriateness of therapy. However, the data already suggest frequent inappropriate use of antimicrobial therapy, in particular the use of prolonged maintenance doses.The reliability of data collection and interpretation, especially when more than one person is involved, is critical for the reproducibility of IRIS. To obtain reliable data we recommend to validated all (possible) HAI with the NH physician and at least one ICP or other dedicated and trained professional.The IRIS has several limitations. First, skin and/or soft tissue infections (SSTI) were not recorded in this survey, as these were not included in the current method of the national surveillance initiative. HoweverSecond, the breakpoints for three categories were based on limited experience and expert opinion. This is largely an arbitrary decision that should be evaluated and adjusted when necessary in the future. Third, not all residents were screened for ESBL-E carriage, which is a potential cause for bias. Overall 83% was screened including all departments of the NHs so we consider this of limited importance. Fourth, the variables included in the IRIS are limited. Hand hygiene compliance was not measured in this survey due to the time investment it takes to perform adequate compliance observations. In retrospect this is a missed opportunity that will be added to the IRIS in the future.Furthermore, it can be considered to include the turnover of HCW, the staffing level and the education level of the staff in the model. Others have found that these factors are associated with the occurrence of HAI in NH.Finally, results from the smaller NH should be interpreted carefully due to the limited sample size. In this case the high prevalence rates have to be confirmed by additional measurements. We therefore recommend performing the IRIS only in NH with more than 50 residents and even in those settings a single measurement should be interpreted with caution. Also, the breakpoints for some measures, e.g. HAI, are relatively narrow considering the random-variation of the point prevalence estimates.The IRIS provided a relatively rapid and complete view of the current state of infection control in NH. There was substantial variation between the different NH and this provided different conclusions for the individual NH. The visualisation in a risk plot was helpful to provide feedback because it was easy-to-read and explained itself to a large extend. Feedback of the IRIS was the trigger to start an extensive improvement program on multiple fields. Whether the results obtained by the IRIS will eventually lead to measurable reduction in HAI requires further studies.The most remarkable finding were the striking differences in ESBL carriage rates between the NH. These outbreaks are currently under investigation for the sources and transmission routes. The effects of the improvement program can be measured in a repeated measurement. In that way a quality control circle with continuous improvement can be achieved. Therefore, the IRIS can be a valuable tool to provide a holistic assessment of infection control and quality improvement focusing on infection control.AP: Anus preaternaturalis; ATP: Adenosine triphosphate; CDC: Center for disease control and prevention; ESBL: Extended spectrum beta-lactamase; ESBL-E: Extended spectrum beta-lactamase producing enterobacteriaceae; HAI: Healthcare associated infections; HCW: Healthcare worker; ICP: Infection control practitioner; IRIS: Infection control risk scan; NH: Nursing home; PEG: Percutaneous endoscopic gastrostomy; SSTI: Skin soft tissue infection; TSB-VC: Tryptic soy broth containing vancomycin and cefotaxim.All authors report no conflicts of interest relevant to this article.IW, JN, YH and JK designed the study. JN and YH assembled all input data. AM and SV coordinated and supported the communication within the study setting. IW, MK and JK analysed the data. All authors discussed the results and implications. IW and JK wrote the manuscript. JN, YH, AM, SV and MK commented on the manuscript at all stages. All authors read and approved the final manuscript.Characterisation of the resident population and risk classification of the infection risks: low-, medium- and high risk.Click here for file


Emotional intelligence (EI) is a multi-faceted construct consisting of our ability to perceive, monitor, regulate and use emotions. Despite much attention being paid to the neural substrates of EI, little is known of the spontaneous brain activity associated with EI during resting state. We used resting-state fMRI to investigate the association between the amplitude of low-frequency fluctuations (ALFFs) and EI in a large sample of young, healthy adults. We found that EI was significantly associated with ALFFs in key nodes of two networks: the social emotional processing network  and the cognitive control network . These findings suggest that the neural correlates of EI involve several brain regions in two crucial networks, which reflect the core components of EI: emotion perception and emotional control. Emotional intelligence (EI) is the capacity to process emotional information accurately and effectively, including the ability to monitor one's own and others' feelings and emotions, discriminate among them and use this information to guide one's thinking and actions EI is generally considered as a multidimensional construct Previous neuroimaging studies suggested that the various aspects of EI were supported by separate neural substrates. The social cognition network (SCN) facilitates the understanding of others' feelings, thoughts or desires Although previous studies mainly focused on structural or anatomical neuroimaging to investigate the EI-related brain regions and networks, it is necessary to pay more attention to explore the underlying spontaneous brain activity related to EI. The spontaneous fluctuations in the blood oxygen level dependent (BOLD) signal reveal the intrinsic functional architecture of the brain and relate to extrinsic task performance To our knowledge, no study has yet investigated the relationship between the resting state fMRI indicator of ALFF and EI. Thus, in the present study, we explored the ALFFs of resting state fMRI signals to elucidate the intrinsic neural basis of EI. As mentioned previously, EI is a multidimensional construct and includes the ability to understand one's own and others' emotions and the ability to regulate and manage emotions. These different processes may involve in emotional information processing and advanced executive control function of the brain. Therefore, we hypothesized that EI might be linked to several brain regions or networks, such as emotion processing networks, cognitive control networks, salience networks or default mode networks.The procedure of this study was approved by the Ethics Committee of the Southwest University. Written informed consent was obtained from all participants. They were informed that the experiment was completely voluntary and they can quit at any time during the experiment. Two of the participants are less than 18 years old, so written informed consent was obtained from their parents on behalf of them.One hundred and seventy participants were recruited to take part in this study. Seven of them exhibited excessive head motion and two failed to register to the standard Montreal Neurological Institute (MNI) space in data preprocessing and thus were excluded. Finally, one hundred and sixty-one individuals were included in the formal analysis. All the participants were healthy, right-handed college students  with no history of neurological or psychiatric disorders. Each participant was required to complete the emotional intelligence scale immediately after the rest-state scanning.αs) of the total scale and four subscales were 0.92, 0.84, 0.92, 0.70 and 0.90, respectively.All the participants completed the Chinese version of the Wong and Law Emotional Intelligence Scale (WLEIS), a 16-item self-report questionnaire designed to measure trait EI MRI data were obtained using a 3.0 Tesla Siemens Trio scanner  in Southwest University, China. First, high-resolution anatomical images were acquired sagittally with the following parameters: 128 slices, 2530/3.39 ms (TR/TE), 1.33 mm (thickness), 256*256 mm (FOV), 1100 ms (inversion time), 7° (flip angle). In addition, an echo-planar imaging sequence was used to collect resting state functional images, and the acquisition parameters were: 33 axial slices; slice thickness, 3 mm; repetition time (TR), 2 s; echo time (TE), 30 ms; image matrix, 64*64; flip angle, 90°; field of view (FOV), 200*200 mm; and 240 volumes. During the resting state scanning, participants were instructed to lay still with eyes closed, and not to think of anything in particular.http://www.fil.ion.ucl.ac.uk/spm) and Data Processing Assistant for Resting-State fMRI (DPARSF) The anatomical and functional image preprocessing was performed using SPM8  in the gray matter mask.ALFF analysis p<0.05  was set.A multiple regression analysis was conducted to examine the correlations between the mean ALFF values and the EI scores. We included gender and age as nuisance covariates in this analysis. Because there is no agreed conclusion about the gender effect on EI ps <0.001) and the correlations between each subscale and the total score ranged from 0.765 to 0.852 (ps <0.001).The means and standard deviations of WLEIS total score and scores on its four subscales are presented in peak  = 0.38, rcluster  = 0.37, ps <0.001), bilateral SMA  and right precuneus , and negatively correlated with ALFFs in the right cerebellum  and right fusiform gyrus .We performed regression analysis to explore the correlations between the brain's regional spontaneous activity and EI. As shown in p<0.05 .Within the subscales of the WLEIS, the following associations were found. As shown in In the present study, we performed ALFF-EI correlation analysis to investigate the neural basis of EI. Our results indicated that inter-individual differences in EI were reflected in the ALFFs during resting state. As expected, EI was linked with some regions that are known to be involved in social and emotional information processing to understand emotions of self and others, such as the fusiform gyrus, right superior orbital frontal gyrus, left inferior frontal gyrus and left inferior parietal lobule. Additionally, some regions in the top-down control network, such as the bilateral pre-SMA, cerebellum and right precuneus were associated with EI, which may contribute to the control of emotional expression.We found ALFFs in the fusiform gyrus were negatively correlated with EI total, SEA, OEA and UOE scores and ALFFs in the superior OFC were negatively correlated with ROE score. These results indicated that people with high EI showed low spontaneous neural activities in these brain regions. The fusiform gyrus and OFC are core parts of the emotional processing network In this study, there was a significant positive relationship between OEA score and ALFFs in the IFG and IPL. The IFG and IPL are important parts of the mirror neuron system Taken together, we provide evidence that EI was significantly associated with ALFFs in certain regions in the social emotional processing network, which is involved in understanding the emotions of self and others.Our results showed a significant positive correlation between EI total, ROE and UOE scores and ALFFs in the bilateral SMA/pre-SMA. By contrast, EI total and four subscales were negatively correlated to ALFFs in the cerebellum. ALFFs in the right precuneus were positively associated with EI total, SEA and UOE scores. The SMA/pre-SMA, cerebellum and precuneus are key nodes of the cognitive control network The cerebellum has neuroanatomical associations with SMA/pre-SMA The precuneus is in the fronto-parietal control network and is involved in initiating and adjusting control This study may have some limitations. First, the subjects in this study were young college students with high educational backgrounds. Their EI may be higher than the average population. Future studies might use more representative samples to test our findings. Second, although these results provide insight into the neural bases of EI, they only revealed EI-related brain regions, and we do not know whether they work together or independently. Furthermore, a framework that relies on domain general, distributed structure–function mappings emerges recently In summary, we examined whether individual differences in the amplitude of spontaneous low-frequency fluctuations (ALFFs) during resting state were predictive of variations in EI. We found that several brain regions were significantly associated with EI, including the bilateral fusiform gyrus, right superior OFC, left IFG and left IPL that belong to the social emotional processing network and the bilateral pre-SMA, cerebellum and right precuneus that are in the top-down control network. These regions are involved in understanding and controlling emotions. These findings provide additional evidence of individual differences in brain spontaneous activity linked to EI and deepen our understanding on the core components of EI.File S1Contains the following files: Text S1. The effect of gender on EI. Table S1. Regions in which ALFF significantly related to WLEIS in the whole-brain analysis. Figure S1. Brain regions exhibited significant correlations between ALFF and WLEIS total score. Figure S2. The common brain regions of (DOC)Click here for additional data file.


These modern phylogenomic studies often entail separate analyses of each of the loci in addition to multiple analyses of subsets of genes or concatenated sequences. Computationally efficient tools for handling and computing properties of thousands of single-locus or large concatenated alignments are needed. Here I present AMAS (Alignment Manipulation And Summary), a tool that can be used either as a stand-alone command-line utility or as a Python package. AMAS works on amino acid and nucleotide alignments and combines capabilities of sequence manipulation with a function that calculates basic statistics. The manipulation functions include conversions among popular formats, concatenation, extracting sites and splitting according to a pre-defined partitioning scheme, creation of replicate data sets, and removal of taxa. The statistics calculated include the number of taxa, alignment length, total count of matrix cells, overall number of undetermined characters, percent of missing data, AT and GC contents , count and proportion of variable sites, count and proportion of parsimony informative sites, and counts of all characters relevant for a nucleotide or amino acid alphabet. AMAS is particularly suitable for very large alignments with hundreds of taxa and thousands of loci. It is computationally efficient, utilizes parallel processing, and performs better at concatenation than other popular tools. AMAS is a Python 3 program that relies solely on Python’s core modules and needs no additional dependencies. AMAS source code and manual can be downloaded from  The amount of data used in modern phylogenetics has increased dramatically since the advent of next-generation sequencing . Data segigadb.org/dataset/101041), DNA and amino acid alignments of 1,478 loci from 144 arthropod taxa from http://datadryad.org/resource/doi:10.5061/dryad.3c0f1), and amino acid alignments of 5,214 exons from 19 hymenopteran taxa from datadryad.org/resource/doi:10.5061/dryad.jt440).To assess and compare the performance of the concatenation fuctions of AMAS, FASconCAT-G, and Phyutility, I used four recently published phylogenomic data sets: filtered DNA alignments of 8,295 exons of 52 vertebrates and 3,679 UCE loci of 49 amniote taxa https://www.zfmk.de/en/research/research-centres-and-groups/fasconcat-g and used according to the user manual provided along with the software download. Concatenation runs with FASconCAT-G were done in two modes: with the -i option that prevents the program from simultaneous calculation of alignment statistics for faster computing times, and with simultaneous writing of the statistics. The former is comparable with the AMAS concatenation option. Phyutility  Core(TM) i7-4930K CPUs at 3.40 GHz, 32 GB of DDR3 RAM at 1,600 Hz, a generic 4TB 7,200 rpm hard drive, and a Ubuntu 12.04LTS operating system with Python 3.4.3 installed.time -p to evaluate execution times. Each command was run three times with minimal background system load and average time recorded.I used the Unix command MetaAlignment class that allows the user to interact with the data using the program as a Python module, in addition to the command line. Using the MetaAlignment methods the user can interact directly with basic alignment meta data and components such as file names, taxa, and constituent sequences using tools for correct parsing of input and output formatting.When used from the command line, AMAS parses input files along with associated metadata into taxon names and sequences stored as basic Python object types such as strings, lists, dictionaries, and tuples. Summary calculations or manipulations such as concatenation or taxon removal are then performed on those objects. Following any action requested by the user, AMAS composes strings in appropriate, requested format and writes output into files. A visual explanation of several AMAS functions is provided in http://github.com/marekborowiec/AMAS/ or at Python’s Package index at https://pypi.python.org/pypi/amas/. AMAS has been tested on a number of data sets to assure that all supported formats are correctly parsed. It is a project under active development and, following user suggestions, additional features are likely to be implemented in the future.The open source code of AMAS and its manual are available at MetaAlignment class and its methods to handle multiple sequence alignments. All the major functions available on the command line are available through this interface but additional flexibility is added by being able to directly manipulate parsed sequences and use built-in methods. A discussion of available methods is available in the manual supplied with the package. I focus on the command line options when discussing AMAS capabilities below.AMAS uses the custom argparse module to handle user-provided arguments (or flags) and is agnostic of the order in which they are given. Correct specification of the input format is crucial for correct parsing of the files. While AMAS takes minimal measures to detect if the right format was given, there is a trade-off between computation time and automated detection of file formats. Detailed usage instructions are provided in the instruction manual and example input/output is visualized in AMAS requires the user to supply information on the alignment: (1) the name of input file(s), (2) the input format, and (3) whether it contains nucleotide or amino acid sequences. The user also needs to specify one action to be performed by the program. These actions are explained below. AMAS uses Python’s AMAS allows easy conversion of formats  for thouIn addition to conversion, AMAS is fast at concatenation  and the AMAS allows the user to create concatenated alignments from a number of randomly chosen alignments that can be used for, for example, the phylogenetic jackknife . AssuminAMAS allows writing files from input alignments, given a list of sites . This caIt is also easy to trim taxa from alignments using AMAS .Finally, AMAS can calculate alignment properties that include the number of taxa, alignment length, total number of matrix cells, overall number of undetermined characters, percent of missing data, AT and GC contents , number and proportion of variable sites, number and proportion of parsimony informative sites, and counts of all characters in a given amino acid or nucleotide alphabet. An example of summary output for data sets used here for benchmarks can be found in I assessed the performance of AMAS on four alignments ranging from, when concatenated, approximately 57 to 705 million matrix cells in total and occupying ca. 56 to 681 MB of hard drive space as FASTA files. The alignment length in total number of sites (amino acids or DNA bases), number of matrix cells, percent of missing data, and proportion of parsimony-informative sites, as calculated by AMAS, are given in Conversion among formats is fast with AMAS. The data set of 5,214 alignment files from Concatenation is a function that can be performed by two other popular programs that are used for alignment manipulations in phylogenomic data sets: FASconCAT-G, a Perl program  and PhyuThe times required for computing summaries are similar regardless of whether the data sets are processed as many single-locus alignments or a concatenated matrix and I present the results on concatenated alignments only . These aThe process of splitting concatenated files is also very fast. AMAS wrote 5,214 files from partitions of the AMAS is a fast program, suitable for simple manipulations useful in phylogenetic inference. It is robust to various input data formats and outperforms other popular programs at concatenation without any cost in accuracy. It is also potentially much more flexible because of its design as a Python package. Future improvements to AMAS are anticipated, including sequence recoding, translation, and adding functions to manipulate the alignments on a by-taxon basis.The biggest advantage of AMAS is the very fast processing of input that can be performed through command line interface as well as a Python module import. It is user friendly and provides flexibility as a Python package for the experienced user, at the same time being useful for a person without scripting experience or someone simply wishing to perform basic operations quickly from the command line. While built-in module functions of AMAS are not as extensive as those available in more sophisticated Python libraries such as Biopython , focus sThe continuing growth in the amount of sequence data used in phylogenetics may require that even faster similar tools be developed soon, taking advantage of compiled languages such as C++ or Julia. At present, however, AMAS offers a tool that is available to any potential user with access to a command line interface, allowing fast computing on some of the largest alignments published to date.10.7717/peerj.1660/supp-1Table S1Click here for additional data file.10.7717/peerj.1660/supp-2Table S2Click here for additional data file.