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The middle of the second until the middle of the first century BCE is one of the most creative periods in the history of human thought, and an important part of this was the interaction between Roman jurists and Hellenistic philosophers. In this highly original book, René Brouwer shows how jurists transformed the study of law into a science with the help of philosophical methods and concepts, such as division, rules and persons, and also how philosophers came to share the jurists' preoccupations with cases and private property. The relevance of this cross-fertilization for present-day law and philosophy cannot be overestimated: in law, its legacy includes the academic study of law and the Western models of dispute resolution, while in philosophy, the method of casuistry and the concept of just property.
Early identification of patients with mental health problems in need of highly specialised care could enhance the timely provision of appropriate care and improve the clinical and cost-effectiveness of treatment strategies. Recent research on the development and psychometric evaluation of diagnosis-specific decision-support algorithms suggested that the treatment allocation of patients to highly specialised mental healthcare settings may be guided by a core set of transdiagnostic patient factors.
To develop and psychometrically evaluate a transdiagnostic decision tool to facilitate the uniform assessment of highly specialised mental healthcare need in heterogeneous patient groups.
The Transdiagnostic Decision Tool was developed based on an analysis of transdiagnostic items of earlier developed diagnosis-specific decision tools. The Transdiagnostic Decision Tool was psychometrically evaluated in 505 patients with a somatic symptom disorder or post-traumatic stress disorder. Feasibility, interrater reliability, convergent validity and criterion validity were assessed. In order to evaluate convergent validity, the five-level EuroQol five-dimensional questionnaire (EQ-5D-5L) and the ICEpop CAPability measure for Adults (ICECAP-A) were administered.
The six-item clinician-administered Transdiagnostic Decision Tool demonstrated excellent feasibility and acceptable interrater reliability. Spearman's rank correlations between the Transdiagnostic Decision Tool and ICECAP-A (−0.335), EQ-5D-5L index (−0.386) and EQ-5D-visual analogue scale (−0.348) supported convergent validity. The area under the curve was 0.81 and a cut-off value of ≥3 was found to represent the optimal cut-off value.
The Transdiagnostic Decision Tool demonstrated solid psychometric properties and showed promise as a measure for the early detection of patients in need of highly specialised mental healthcare.
Many cognitive functions are under strong genetic control and twin studies have demonstrated genetic overlap between some aspects of cognition and schizophrenia. How the genetic relationship between specific cognitive functions and schizophrenia is influenced by IQ is currently unknown.
We applied selected tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB) to examine the heritability of specific cognitive functions and associations with schizophrenia liability. Verbal and performance IQ were estimated using The Wechsler Adult Intelligence Scale-III and the Danish Adult Reading Test. In total, 214 twins including monozygotic (MZ = 32) and dizygotic (DZ = 22) pairs concordant or discordant for a schizophrenia spectrum disorder, and healthy control pairs (MZ = 29, DZ = 20) were recruited through the Danish national registers. Additionally, eight twins from affected pairs participated without their sibling.
Significant heritability was observed for planning/spatial span (h2 = 25%), self-ordered spatial working memory (h2 = 64%), sustained attention (h2 = 56%), and movement time (h2 = 47%), whereas only unique environmental factors contributed to set-shifting, reflection impulsivity, and thinking time. Schizophrenia liability was associated with planning/spatial span (rph = −0.34), self-ordered spatial working memory (rph = −0.24), sustained attention (rph = −0.23), and set-shifting (rph = −0.21). The association with planning/spatial span was not driven by either performance or verbal IQ. The remaining associations were shared with performance, but not verbal IQ.
This study provides further evidence that some cognitive functions are heritable and associated with schizophrenia, suggesting a partially shared genetic etiology. These functions may constitute endophenotypes for the disorder and provide a basis to explore genes common to cognition and schizophrenia.
Currently, reimbursement decisions based on health technology assessments (HTA) in the Netherlands mostly concern outpatient pharmaceuticals. The Dutch government aspires to broaden the systematic application of full HTA towards other types of health care in order to optimise the content of the basic benefit package. This paper identifies important challenges for broadening the scope of full HTA to other types of health care. Based on a description of the Dutch reimbursement decision-making process, five important characteristics of outpatient pharmaceuticals were identified, which are all relevant to the successful application of HTA: (i) closed reimbursement system, (ii) absence of alternative policy measures, (iii) existence of marketing authorisation, (iv) identifiable and accountable counterparty, and (v) product characteristics. For a selection of other types of health care, which may be subject to HTA more frequently in the future, deviations from these characteristics of outpatient pharmaceuticals are discussed. The implications of such deviations for performing HTA and the decision-making process are highlighted. It is concluded that broadening the application of HTA will require policy makers to meet both important policy-related and methodological challenges. These challenges differ per health care domain, which may inform policy makers which expansions of the current use of HTA are most feasible.
When talking about decisionmaking for children with a life-threatening condition, the death of children with brain tumors deserves special attention. The last days of the lives of these children can be particularly harsh for bystanders, and raise questions about the suffering of these children themselves. In the Netherlands, these children are part of the group for whom a wide range of end-of-life decisions are discussed, and questions raised. What does the end-of-life for these children look like, and what motivates physicians and parents to make decisions that may affect the life and death of these children? This article highlights the story of the parents of the sisters Roos and Noor. When both their daughters were diagnosed with a hereditary brain tumor, they had to make similar decisions twice. Their story sheds light on the suffering of children in the terminal phase, and how this suffering may motivate parents and physicians to make decisions that influence the end of life of these children’s lives.
We argue that complete knowledge about suffering in the terminal phase of children with brain tumors is impossible. However, by collecting experiences like those of Roos and Noor, we can move toward an experienced-based understanding and better guide parents and physicians through these hardest of decisions.
This study examined whether the Foreign-Language effect, an increase in bilinguals’ rate of rational decisions to moral dilemmas in their foreign versus their native language, is influenced by emotion and the modality in which the dilemmas are presented. 154 Dutch–English bilinguals were asked to read and listen to personal and impersonal moral dilemmas in Dutch or in English. Importantly, the reading task had the character of a self-paced reading task to resemble the listening task as closely as possible. In both modalities, participants’ task was to indicate whether the proposed action was appropriate or not. Results showed that the Foreign-Language effect was present for personal dilemmas only. In addition, an effect of modality demonstrated that participants took overall more rational decisions during the listening than the reading task. These findings give insight in the interplay between language, emotion and task demands, revealing that moral decision making is context-dependent.
Symptoms that are linked to schizophrenia and other psychotic disorders, such as auditory verbal hallucinations (AVH), are also commonly reported by individuals who function well in society. These individuals are not in need for care, do not suffer from schizotypal personality disorder or other psychotic disorders, and provide the opportunity to investigate the relationship between nonclinical psychotic symptoms and brain morphology.
Fifty individuals with nonclinical AVH, 50 patients with a psychotic disorder and AVH, and 50 healthy controls underwent structural magnetic resonance imaging. The three groups were matched for age, gender, handedness and years of parental education. Cortical thickness was assessed using the FreeSurfer software suite.
Cortical thickness in the left pars orbitalis, left paracentral gyrus, right fusiform gyrus and right inferior temporal gyrus was lowest in patients, intermediate in the nonclinical AVH group, and highest in controls. The patients also showed additional cortical thinning in widespread frontal, temporal and parietal areas compared to both other groups. In additional analysis, ranking the levels of cortical thickness per brain region across groups revealed that for the large majority of brain regions (88%), the patients had the lowest cortical thickness, the nonclinical individuals with AVH were in between, and the control subjects had the highest cortical thickness.
Individuals with nonclinical psychotic symptoms show a similar but less pronounced pattern of cortical thinning as patients with a psychotic disorder, which is suggestive of a similar, but milder underlying pathophysiology in the nonclinical hallucinating group compared to the psychosis group.
A new competency-based job framework was implemented for clinical research professionals at a large, clinical research-intensive academic medical center. This study evaluates the rates of turnover before and after implementation of the new framework. Turnover in this workforce (as with most) is costly; it contributes to wasted dollars and lost productivity since these are highly specialized positions requiring extensive training, regardless of experience in the field.
Trends in employee turnover for 3 years prior to and after the implementation of competency-based job framework for clinical research positions were studied using human resources data. Employee demographics, turnover rates, and comparisons to national statistics are summarized.
Employee turnover within the clinical research professional jobs has decreased from 23% to 16%, a 45% reduction, since the implementation of competency-based job framework.
The new jobs and career ladders, both of which are centered on a competency-based framework, have decreased the overall turnover rate in this employee population. Since little is known about the rates of turnover in clinical research, especially in the academic medical setting, the results of this analysis can provide important insights to other academic medical centers on both employee turnover rate in general and the potential impact of implementing large-scale competency-based job changes.
To gain insight in Dutch food bank recipients’ perception on the content of the food parcels, their dietary intake and how the parcels contribute to their overall dietary intake.
Eleven semi-structured focus group discussions were conducted. Focus group topics were based on Andersons food insecurity definition: the lack of availability of nutritionally adequate foods and the assured ability to acquire foods in socially acceptable ways. Data were coded and analysed with Atlas.ti 7.0 software, using the framework approach.
Seven food banks throughout the Netherlands.
A total of 44 Dutch food bank recipients.
Food bank recipients were not always satisfied with the amount, quality, variation and type of foods in the food parcel. For the participants who could afford to, supplementing the food parcel was reported as main reason for buying foods, and price was the most important aspect in selecting these foods. Participants were not satisfied with their dietary intake; they mainly reported not having enough to eat. The content of the food parcel importantly influenced participants’ overall dietary intake. Finally, participants reported struggling with their feelings of dissatisfaction, while also being grateful for the foods they receive.
This study suggests that, despite their best efforts, food banks are not meeting food bank recipients’ needs. Our results provide valuable directions for improving the content of the food parcels by increasing the quantity, quality and variation in the foods supplied. Whether this also improves the dietary intake of recipients needs to be determined.
Triage at mass gatherings in Australia is commonly performed by staff members with first aid training. There have been no evaluations of the performance of first aid staff with respect to diagnostic accuracy or identification of presentations requiring ambulance transport to hospital.
It was hypothesized that triage decisions by first aid staff would be considered correct in at least 61% of presentations.
A retrospective audit of 1,048 presentations to a single supplier of event health care services in Australia was conducted. The presentations were assessed based on the first measured set of physiological parameters, and the primary triage decision was classified as “expected” if the primary and secondary triage classifications were the same or “not expected” if they differed. The performance of the two triage systems was compared using area under the receiver operating characteristic curve (AUROC) analysis.
The expected decision was made by first aid staff in 674 (71%) of presentations. Under-triage occurred in 131 (14%) presentations and over-triage in 142 (15%) presentations. The primary triage strategy had an AUROC of 0.7644, while the secondary triage strategy had an AUROC of 0.6280, which was significantly different (P = .0199).
The results support the continued use of first aid trained staff members in triage roles at Australian mass gatherings. Triage tools should be simple, and the addition of physiological variables to improve the sensitivity of triage tools is not recommended because such an approach does not improve the discriminatory capacity of the tools.
To examine mediation by (i) diet quality and (ii) diet quantity in the associations of mindful eating domains with 3-year change in depressive symptoms.
Depressive symptoms were measured with the Center for Epidemiologic Studies Depression scale at baseline and 3-year follow-up. Four mindful eating domains (Focused Eating; Eating in response to Hunger and Satiety Cues; Eating with Awareness; Eating without Distraction) were measured with the Mindful Eating Behavior Scale. Food intake was measured with a 238-item FFQ. Diet quality was defined as the Mediterranean Diet Score (MDS). Diet quantity was defined as total energy intake (kcal/d; 1 kcal = 4·184 kJ). Mediation analyses with percentile-corrected bootstrap confidence intervals were conducted to calculate indirect effects.
Longitudinal Aging Study Amsterdam.
Adults aged 55 years or above (n 929).
Diet quality (MDS) did not mediate associations of any of the four mindful eating domains with change in depressive symptoms. In contrast, total energy intake did mediate the associations with change in depressive symptoms for the mindful eating domains Eating with Awareness (indirect effects fully adjusted models: B = −0·014, 95 % CI −0·037, −0·002) and Eating without Distraction (B = −0·013, 95 % CI −0·033, −0·001), but not for the other two domains. Post hoc multiple mediation analyses showed similar results.
Higher scores on two mindful eating domains were associated with a decrease in depressive symptoms through lower total energy intake. Diet quantity, but not diet quality, could be a possible underlying mechanism in the associations between mindful eating and change in depressive symptoms.
Navigating the research domain at an academic medical center can be challenging, even for seasoned investigators. To address this, Duke University launched two initiatives: (1) a research navigation “hotline” to provide brief assistance with a variety of research questions; and (2) researcher onboarding and consultation, a one-to-one tailored offering to ensure that researchers are equipped to navigate research resources and processes effectively. The services are provided by the myRESEARCHnavigators (MRN) team, funded by Duke’s CTSA. The diverse scientific backgrounds of the six team members align well with those of the research community, allowing for a good match between the researcher and MRN team member. The MRN team answers approximately 30 questions per month, and has provided consultations to almost 400 researchers. Both services receive high satisfaction ratings (4 or 5 stars [out of 5 stars] given to 90% of hotline answers, and 99% of researcher onboarding/consultation sessions). As of July 2019, the School of Medicine has determined that the consultations are critical to their mission and have made them a requirement for new research faculty. The team will continue marketing both services to encourage adoption.
Since food banks have a strong influence on recipients’ diets, and seem to have difficulties in supporting healthy diets, improving the dietary quality of food parcels is important. Therefore, we aimed to assess whether improving the dietary quality of food parcels, using different strategies, can positively impact the actual dietary intake of Dutch food bank recipients.
Materials and methods:
This randomized cross-over controlled trial with four intervention conditions [1) Control (standard food parcel), 2) Snacks– (standard food parcel with replacement of snacks by staple foods), 3) FV + (standard food parcel plus the recommended daily amount of fruit and vegetables), 4) Snacks– + FV (standard food parcel with replacement of snacks by staple foods plus the recommended daily amount of fruit and vegetables)] included food bank recipients from three food banks. In total, 199 recipients were randomly allocated. At baseline, participants filled in a questionnaire and underwent anthropometric measurements. Dietary intake data were collected through 24-hour recalls after both intervention conditions at 4 and 8 weeks follow-up. Primary outcome was fruit and vegetable intake, secondary outcomes were dietary intakes of food groups and nutrients.
Multi-level linear regression analysis, using a two-level model showed a higher mean fruit intake in participants in the FV + condition than in participants in the Control condition (δ: 74 [40.3;107.6] g). Both mean fruit and mean vegetable intake were higher in participants in the Snacks– + FV + condition than in participants in the Control condition (fruit δ: 81.3 [56.5;106.2] g; vegetable: δ: 46.2 [17.5;74.9] g), as well as in the Snacks– condition (fruit: δ: 70.0 [38.8;101.1] g; vegetable δ: 62.2 [26.2; 98.2] g).
This study shows that improving the dietary content of food parcels can positively impact the dietary intake of Dutch food bank recipients. With this we can further develop effective strategies to improve dietary intake of food bank recipients.
When tuberculosis (TB) and depression co-occur, there is greater risk for comorbidities, disability, suffering, and health-related costs. Depression is also associated with poor treatment adherence in patients with TB. The major aim of this study was to assess the symptoms of depression and associated factors among TB patients currently receiving directly observed treatment short-course (DOTS) treatment.
A cross-sectional study was conducted among TB patients currently undergoing treatment in 27 DOTS centers in three districts of Kathmandu Valley. The study included 250 TB patients within 2 months of treatment initiation, aged 18 years and above. The previously validated Nepali Patient Health Questionnaire (PHQ-9) was used to screen for depression and semi-structured interviews were conducted to collect socio-demographic information and other factors related to TB and/or depression. Data analysis was conducted using IBM SPSS Statistics version 20.
The study found the mean PHQ Score to be 2.84 (s.d. 4.92, range 0–25). Among the respondents, 10% (n = 25) had PHQ-9 scores ⩾10, suggestive of probable depression. Multivariate linear regression indicated that depressive symptoms were significantly associated with being separated/widowed/divorced (p = 0.000) and having lower education (0.003). In addition, smoking (p = 0.02), alcohol use (p = 0.001), and experience of side effects from TB medications (p = 0.001) were risk factors for higher PHQ-9 scores.
Our findings suggest that patients on TB treatment have higher risk of depression and efforts should be made by the National Tuberculosis Program to address this issue.
Review findings on the role of dietary patterns in preventing depression are inconsistent, possibly due to variation in assessment of dietary exposure and depression. We studied the association between dietary patterns and depressive symptoms in six population-based cohorts and meta-analysed the findings using a standardised approach that defined dietary exposure, depression assessment and covariates.
Included were cross-sectional data from 23 026 participants in six cohorts: InCHIANTI (Italy), LASA, NESDA, HELIUS (the Netherlands), ALSWH (Australia) and Whitehall II (UK). Analysis of incidence was based on three cohorts with repeated measures of depressive symptoms at 5–6 years of follow-up in 10 721 participants: Whitehall II, InCHIANTI, ALSWH. Three a priori dietary patterns, Mediterranean diet score (MDS), Alternative Healthy Eating Index (AHEI-2010), and the Dietary Approaches to Stop Hypertension (DASH) diet were investigated in relation to depressive symptoms. Analyses at the cohort-level adjusted for a fixed set of confounders, meta-analysis used a random-effects model.
Cross-sectional and prospective analyses showed statistically significant inverse associations of the three dietary patterns with depressive symptoms (continuous and dichotomous). In cross-sectional analysis, the association of diet with depressive symptoms using a cut-off yielded an adjusted OR of 0.87 (95% confidence interval 0.84–0.91) for MDS, 0.93 (0.88–0.98) for AHEI-2010, and 0.94 (0.87–1.01) for DASH. Similar associations were observed prospectively: 0.88 (0.80–0.96) for MDS; 0.95 (0.84–1.06) for AHEI-2010; 0.90 (0.84–0.97) for DASH.
Population-scale observational evidence indicates that adults following a healthy dietary pattern have fewer depressive symptoms and lower risk of developing depressive symptoms.
Spatial models are increasingly being used to target the most suitable areas for biodiversity conservation. This study investigates how the spatial tool Marxan with Zones (MARZONE) can be used to support the design of cost-effective biodiversity conservation policy. New in this study is the spatial analysis of the costs and effectiveness of different agro-environmental measures (AEMs) for habitat and biodiversity conservation in the Montado ecosystem in Portugal. A distinction is made between the financial costs paid to participating landowners and farmers for adopting AEMs and the broader economic opportunity costs of the corresponding land-use changes. Habitat and species conservation targets are furthermore defined interactively with the local government agency responsible for the management of protected areas, while the costs of agro-forestry activities and alternative land uses are estimated in direct consultation with local landowners. MARZONE identifies the spatial distribution of priority areas for conservation and the associated costs, some of which overlap with existing protected areas. These results provide useful insights into the trade-offs between nature conservation and the opportunity costs of protecting ecologically vulnerable areas, helping to improve current and future conservation policy design.
While numerous studies have recently shown that variation in input quantity predicts children’s rate of acquisition across a range of language skills, comparatively little is known about the impact of variation in input quality on (bilingual) children’s language development. This study investigated the relation between specific quality-oriented properties of bilingual children’s input and measures of children’s language development across a number of skills while at the same time taking family constellation into account. Participants were bilingual preschoolers (n = 50) acquiring Dutch alongside another language. Preschoolers’ receptive and productive vocabulary and morphosyntax in Dutch were assessed. Parental questionnaires were used to derive estimates of input quality. Family constellation was first operationalized as presence of a native-speaker parent and subsequently in terms of patterns of parental language use. Results showed that proportion of native input and having a native-speaker parent were never significant predictors of children’s language skills, whereas the degree of non-nativeness in the input, family constellation in terms of parental language use, and language richness were. This study shows that what matters is not how much exposure bilingual children have to native rather than non-native speakers, but how proficient any non-native speakers are.
Families with neurodevelopmental disorders engage in varied types of therapies to address behavioural, communication and cognitive challenges. Research suggests that consistent therapy adherence predicts positive therapy outcomes. The present study examined therapy adherence in 55 parent-child dyads where all children had been diagnosed with ASD, ADHD, and/or ID. Parents completed questionnaires assessing demographics, therapy type, adherence to child treatment, parental stress, and challenging child behaviour. The researchers proposed a new scale, the Child Therapy Adherence Scale (CTAS), which initial testing supported as a reliable measure of therapy adherence. Significant relationships were found between parental stress, annual household income and therapy adherence, with parental stress being a notably strong predictor of therapy adherence. No significant relationships were observed between child challenging behaviour, single parent status and therapy adherence. These findings have implications for practitioners, in that parent levels of stress and demographic influences may impact capacity to adhere to recommended home practice and interventions for children with neurodevelopmental disorders.
After five positive randomized controlled trials showed benefit of mechanical thrombectomy in the management of acute ischemic stroke with emergent large-vessel occlusion, a multi-society meeting was organized during the 17th Congress of the World Federation of Interventional and Therapeutic Neuroradiology in October 2017 in Budapest, Hungary. This multi-society meeting was dedicated to establish standards of practice in acute ischemic stroke intervention aiming for a consensus on the minimum requirements for centers providing such treatment. In an ideal situation, all patients would be treated at a center offering a full spectrum of neuroendovascular care (a level 1 center). However, for geographical reasons, some patients are unable to reach such a center in a reasonable period of time. With this in mind, the group paid special attention to define recommendations on the prerequisites of organizing stroke centers providing medical thrombectomy for acute ischemic stroke, but not for other neurovascular diseases (level 2 centers). Finally, some centers will have a stroke unit and offer intravenous thrombolysis, but not any endovascular stroke therapy (level 3 centers). Together, these level 1, 2, and 3 centers form a complete stroke system of care. The multi-society group provides recommendations and a framework for the development of medical thrombectomy services worldwide.