Most coastal marine organisms have a dispersive oceanic larval stage, during which they must be able to distinguish and respond to relevant environmental cues when settling into their first benthic habitat. Chemical stimuli emanating from settlement habitats and being dispersed by water plumes could enable long-distance navigation by larval reef fish, but we know little about the cues responsible and their interactive effects. In the present study, we tested this by conducting several ex situ choice experiments in which the response of the coral reef fish Lutjanus fulviflamma towards different chemical cues from coastal habitats was tested close to their settlement stage. Fish preferred seagrass habitat water over that from coral reef and mangrove habitats. Furthermore, fish were attracted to chemical cues from their own species (conspecifics) and other fish species, as well as vegetation of 4 different seagrass species, when offered in isolation (i.e. soaked in neutral water), but a strong response remained only towards cues from conspecifics and seagrass leaves when these cues were mixed with seagrass habitat water that naturally contains other cues. Hierarchical effects were observed as fish preferred chemical cues from seagrass leaves over those from conspecifics when both were offered at the same time. The importance of visual habitat cues only overruled that of chemical cues when it concerned preferred cues (i.e. seagrass as opposed to mangrove cues). Our findings indicate that pelagic fish and settlers possess the ability to use multiple reliable chemical cues to locate suitable early life stage habitats, although the importance of these cues is context-dependent. Nevertheless, this flexibility in choice behavior is probably an adaptive strategy to enhance fitness by increasing successful orientation towards preferred settlement habitats.
Background:Onychomycosis,the most common cause of nail dystrophy is generally diagnosed by clinical examination. Current guidelines for Dutch general practice advise confirmatory testing onlyin case of doubt or insufficient response to treatment. However, making a correct diagnosis can be challenging given the wide variety of clinical features and differential diagnosis.Aim:To establish accuracy of clinical diagnosis of onychomycosis by general practitioners (GPs).Design and Setting:A diagnostic accuracy study based on GPs clinical diagnosis of primary care patients suspected of onychomycosis.Methods:Using 137 complete data sets from the Onycho Trial, diagnostic accuracy of clinical diagnosis as index test was compared with confirmatory testing as reference test.A sensitivity analysis was performed to determine diagnostic values for different combinations of index and reference test. Logistical regression was usedto assess whichclinical characteristics were associated with the positive predictive value (PPV) of the index test.Results:Clinical accuracy i.e. the PPV of the index testwas 74.5%. Sensitivity analysisshowed no significant difference in diagnostic values. Male gender and a history of any previous treatmentsignificantly increased clinical accuracy with an OR of 3.873 (95% C.I. 1.230 – 12.195) and 4.022 (95% C.I. 1.075 – 15.040), respectively.Conclusion:Our study demonstratesthat theGPs clinical diagnosis of onychomycosis is insufficiently accurate to initiate treatment without confirmatory testing.Further research is needed to investigate how to increase clinical accuracy and reduce potentially unnecessary exposure to treatment.
Nosocomial bloodstream infections (NBSIs), commonly due to central-line associated bloodstream infections (CLABSI), contribute substantially to neonatal morbidity and mortality. We aimed to identify longitudinal changes in incidence of NBSI, microbiological-spectrum, and antibiotic exposure in a large cohort of preterm neonates admitted to the neonatal intensive care unit. We retrospectively assessed differences in annual rates of NBSI (per 1000 patient-days), CLABSI (per 1000 central-line days), and antibiotic consumption (per 1000 patient-days) among preterm neonates (< 32 weeks’ gestation) hospitalized between January 2012 and December 2020. Multi-state Markov models were created to model states of progression of NBSI and infection risk given a central-line on days 0, 3, 7, and 10 of admission. Of 1547 preterm infants, 292 (19%) neonates acquired 310 NBSI episodes, 99 (32%) of which were attributed to a central-line. Over the years, a significant reduction in central-line use was observed (p < 0.001), although median dwell-time increased (p = 0.002). CLABSI incidence varied from 8.83 to 25.3 per 1000 central-line days, with no significant difference between years (p = 0.27). Coagulase-negative staphylococci accounted for 66% of infections. A significant decrease was found in antibiotic consumption (p < 0.001). Probability of NBSI decreased from 16% on day 3 to 6% on day 10. NBSI remains a common problem in preterm neonates. Overall antibiotic consumption decreased over time despite the absence of a significant reduction in infection rates. Further research aimed at reducing NBSI, in particular CLABSI, is warranted, particularly with regard to limiting central-line dwell-time and fine-tuning insertion and maintenance practices.
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