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The radiocarbon (14C) dating facility at the Centre for Isotope Research, University of Groningen went through a major upgrade in 2017 and this included installation of a MICADAS accelerator mass spectrometer (AMS). In the first 18 months, we performed 4000 sample and 3000 reference measurements. A careful evaluation of those measurement results is presented, to characterize the various sources of uncertainty and to ultimately assign, for every sample measurement, a realistic expanded uncertainty. This analysis was performed on the measurements of secondary references and sample duplicates in various phases of their processing steps. The final expanded uncertainty includes both the 14C measurement uncertainties and uncertainties originating from pretreatment steps. Where the 14C measurement uncertainty includes straightforward uncertainties arising from Poisson statistics, background subtraction, calibration on Oxalic Acid II and δ13C correction, the uncertainties originating from pretreatment steps are based on the spread of actual measurement results for secondary references and sample duplicates. We show that the 14C measurement uncertainty requires expansion, depending on the number of processing steps involved prior to a 14C measurement, by a maximum factor of 1.6 at our laboratory. By using these expansion (multiplication) factors, we make our reported uncertainty both more realistic and reliable.
Comorbidity has profound implications in both the clinical field and research, yet little is known about the prevalence and structure of comorbid mental disorders. This article aims not only to present data on the prevalence of mental disorders and comorbidity, but also to explore relationships between comorbid mental disorders by using a network approach.
Data used in this cross-sectional study are part of a prospective cohort study within penitentiary psychiatric centers (PPCs) in the Netherlands. It includes DSM diagnoses of 5,257 unique male patients incarcerated in one of the PPC's. Prevalence rates of mental disorders and comorbidity were calculated, the network of comorbid DSM diagnoses was constructed using regression coefficients.
Schizophrenia spectrum and substance-related disorders were most prevalent within this sample (56.7 and 43.1%, respectively), and over half of all patients were diagnosed with a comorbid disorder (56.9%). Four distinctive groups of disorders emerged from the network analysis of DSM diagnoses: substance use, impulsivity, poor social skills, and disruptive behaviors. Psychotic disorders were considered as a separate group as it was unconnected to other disorders.
Comorbid mental disorders can be described, at least in part, as connected networks. Underlying attributes as well as direct influences of mental disorders on one another seem to be affecting the presence of comorbidity. Results could contribute to the understanding of a possible causal relation between psychopathology and criminal behavior and the development of treatment programs targeting groups of disorders.
Four pregnancies in three panic disorder patients are described. In three pregnancies panic symptoms improved initially, but worsened in the second half. One patient developed panic disorder in the second half of her pregnancy. Changes in balance between progesterone and estrogen could explain this clinical course.
Nonadherence to antipsychotic medication is highly prevalent in patients with schizophrenia and has a deleterious impact on the course of the illness. This review seeks to determine the interventions that were examined in the past decade to improve adherence rates.
The literature between 2000 and 2009 was searched for randomized controlled trials which compared a psychosocial intervention with another intervention or with treatment as usual in patients with schizophrenia.
Fifteen studies were identified, with a large heterogeneity in design, adherence measures and outcome variables. Interventions that offered more sessions during a longer period of time, and especially those with a continuous focus on adherence, seem most likely to be successful, as well as pragmatic interventions that focus on attention and memory problems. The positive effects of adapted forms of Motivational Interviewing found in earlier studies, such as compliance therapy, have not been confirmed.
Nonadherence remains a challenging problem in schizophrenia. The heterogeneity of factors related to nonadherence calls for individually tailored approaches to promote adherence. More evidence is required to determine the effects of specific interventions.
It has been estimated that around 10-20% of all pregnant women suffer from antenatal depressive or anxiety symptoms. These symptoms have been associated with multiple adverse child outcomes including obstetric problems, e.g. preterm delivery, Apgar score and low birth weight. Therefore, considerable health gains may be achieved if depression and anxiety during the perinatal period are adequately treated. Nevertheless, to date, no previous trials have published on the effects of Cognitive Behavioral Therapy (CBT) during pregnancy on child outcomes.
The ´Pregnancy Outcomes After a Maternity Intervention for Stressful Emotions´ (PROMISES) trial is a randomized controlled trial, which compares the effects of CBT vs. care as usual (CAU) during pregnancy among a group of women with (sub)clinically depressive and/or anxiety symptoms (n=226) on both maternal and child outcomes. Child outcomes comprise a range of obstetric outcomes including birth weight, Apgar score, and gestational age. Independent samples t-tests were performed to investigate differences in mean values.
No significant differences were found between the CBT- and the CAU-groups, in gestational age (39+0 vs 39+2 weeks+days, p=.99), birth weight (3447 vs 3509 grams, p=.24), or Apgar score at 1 (8.6 vs 8.6, p=.99), 5 (9.5 vs 9.6, p=.31), and 10 minutes (9.7 vs 9.8, p=.26).
Although CBT as early treatment of antenatal depression and anxiety is most likely to be effective for prevention of postpartum depression, CBT seems to have no effect on major obstetric outcomes.
Prevention, identification, and treatment of maternal psychopathology may be favourable for both mother and child. Both a low socio-economic position (SEP) and adverse life events are considered risk factors for symptoms of anxiety and depression during pregnancy. It is unknown whether the effect of adverse life events is modified by SEP.
To investigate the relationship between symptoms of anxiety and depression in pregnancy and adverse life events, and how this relationship is modified by SEP.
The population based Pregnancy, Anxiety and Depression (PAD) Study is a prospective study in Dutch obstetric care. We assessed symptoms of anxiety and depression in pregnant women, SEP (educational level of mother and partner, work status of mother and partner and family income), and the number of adverse life events, categorised by period in life. The association of the number of adverse life events with anxiety and depression, as well as effect modification by SEP was tested using linear regression analyses.
We included 4272 participants. The number of life events and low SEP were independantly associated with symptoms of both anxiety and depression during pregnancy. Additionally, we found that aspects of SEP: low maternal educational level, maternal unemployment, and low family income may increase the adverse effect of adverse life events.
A low SEP increases the adverse impact of adverse life events. In an early screening for anxiety and depression, the number of adverse life events and more important the above-mentioned aspects of SEP should play a key role.
Multimorbidity may impose an overwhelming burden on patients with psychosis and is affected by gender and age. Our aim is to study the independent role of familial liability to psychosis as a risk factor for multimorbidity.
We performed the study within the framework of the Genetic Risk and Outcome of Psychosis (GROUP) project. Overall, we compared 1024 psychotic patients, 994 unaffected siblings and 566 controls on the prevalence of 125 lifetime diseases, and 19 self-reported somatic complaints. Multimorbidity was defined as the presence of two or more complaints/diseases in the same individual. Generalized linear mixed model (GLMM) were used to investigate the effects of gender, age (adolescent, young, older) and familial liability (patients, siblings, controls) and their interactions on multimorbidity.
Familial liability had a significant effect on multimorbidity of either complaints or diseases. Patients had a higher prevalence of multimorbidity of complaints compared to siblings (OR 2.20, 95% CI 1.79–2.69, P < 0.001) and to controls (3.05, 2.35–3.96, P < 0.001). In physical health multimorbidity, patients (OR 1.36, 95% CI 1.05–1.75, P = 0.018), but not siblings, had significantly higher prevalence than controls. Similar finding were observed for multimorbidity of lifetime diseases, including psychiatric diseases. Significant results were observed for complaints and disease multimorbidity across gender and age groups.
Multimorbidity is a common burden, significantly more prevalent in patients and their unaffected siblings. Familial liability to psychosis showed an independent effect on multimorbidity; gender and age are also important factors determining multimorbidity.
Data-driven techniques are frequently applied to identify subtypes of depression and anxiety. Although they are highly comorbid and often grouped under a single internalizing banner, most subtyping studies have focused on either depression or anxiety. Furthermore, most previous subtyping studies have not taken into account experienced disability.
To incorporate disability into a data-driven cross-diagnostic subtyping model.
To capture heterogeneity of depression and anxiety symptomatology and investigate the importance of domain-specific disability-levels to distinguish between homogeneous subtypes.
Sixteen symptoms were assessed without skips using the MINI-interview in a population sample (LifeLines; n = 73403). Disability was measured with the RAND-36. To identify the best-fitting subtyping model, different nested latent variable models (latent class analysis, factor analysis and mixed-measurement item response theory [MM-IRT]) with and without disability covariates were compared. External variables were compared between the best model's classes.
A five-class MM-IRT model incorporating disability showed the best fit (Fig. 1). Accounting for disability improved the differentiation between classes reporting isolated non-specific symptoms (“Somatic” [13.0%], and “Worried” [14.0%]) and those reporting more psychopathological symptoms (“Subclinical” [8.8%], and “Clinical” [3.3%]). A “Subclinical” class reported symptomatology at subthreshold levels. No pure depression or anxiety, but only mixed classes were observed.
An overarching subtyping model incorporating both symptoms and disability identified distinct cross-diagnostic subtypes. Diagnostic nets should be cast wider than current phenomenology-based categorical systems.
Figure not available.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
In this chapter, we discuss the rationale, practice, evidence, and effects of character-based college admissions from both a US and a European perspective. With the increasing globalization, it is important to discuss and evaluate recent developments with respect to selective college admissions. This chapter discusses the rationale for implementing character-based admission criteria in admission testing, admission practices in several European countries, the empirical evidence of the validity and fairness of character-based admission tools, and how academic- and character-based admission criteria are combined.
Perinatal depression and anxiety are associated with unfavourable child outcomes.
To assess among women with antenatal depression or anxiety the effectiveness of prenatally initiated cognitive–behavioural therapy (CBT) on mother and child compared with care as usual (CAU). Trial registration: Netherlands Trial Register number NTR2242.
Pregnant women (n = 282) who screened positive for symptoms of depression and/or anxiety were randomised to either CBT (n = 140) or CAU (n = 142). The primary outcome was child behavioural and emotional problems at age 18 months, assessed using the Child Behavior Checklist (CBCL). Secondary outcomes were maternal symptoms during and up to 18 months after pregnancy, neonatal outcomes, mother–infant bonding and child cognitive and motor development at age 18 months.
In total, 94 (67%) women in the CBT group and 98 (69%) in the CAU group completed the study. The mean CBCL Total Problems score was non-significantly higher in the CBT group than in the CAU group (mean difference: 1.38 (95% CI −1.82 to 4.57); t = 0.85, P = 0.399). No effects on secondary outcomes were observed except for depression and anxiety, which were higher in the CBT group than in the CAU group at mid-pregnancy. A post hoc analysis of the 98 women with anxiety disorders showed lower infant gestational age at delivery in the CBT than in the CAU group.
Prenatally initiated CBT did not improve maternal symptoms or child outcomes among non-help-seeking women with antenatal depression or anxiety. Our findings are not in line with present recommendations for universal screening and treatment for antenatal depression or anxiety, and future work may include the relevance of baseline help-seeking.
As scholars explore opportunities for democratic renewal, the potential of ballot structures to improve the quality of representation has been largely neglected. We argue that expressive ballots can improve the congruence of political preferences between voters and their vote choice and, subsequently, decrease parliamentary polarization. Recognizing that voters’ political preferences are more complex than a dichotomous party-vote allows, we propose the ‘assembly ballot’, which allows voters to choose their ‘ideal parliament’ by distributing 150 parliamentary seats across all participating parties. To assess the consequences of the assembly ballot for ideological congruence and parliamentary composition, we conducted a survey experiment with over 16,000 respondents around the 2017 Dutch parliamentary elections in which respondents cast a vote in a mock-election using the assembly ballot or a closed-list PR ballot. Results show that ideological congruence is, on average, significantly higher for voters voting with the assembly ballot for both the left–right dimension and the cultural dimension, while also producing a more centripetal, less polarized parliament.
Mobility or physical movement contributes to health and wellbeing in later life. Most studies have focused on the contribution of outdoor mobility to active ageing, but physical and cognitive impairments restrict the mobility of many older adults. This article aims to explore the gaps in the current literature on mobility in later life, and identify required innovations in the field through laying out key areas for future research. It discusses two, largely separate, areas of research, namely on mobility patterns and mobility experiences. The first focuses on quantitative and spatial research on outdoor mobility patterns in terms of routes, timing and transport modes. The second mainly concerns qualitative research on how older adults perceive mobility in their everyday lives. This article identifies three areas for future research on mobility in later life: (a) beyond outdoor movement; (b) diversity in mobility; and (c) the role of time in mobility. To conclude, addressing these areas jointly will contribute to further unpacking the concept of mobility as meaningful practice and to integrating quantitative and qualitative methods when studying mobility in later life. This will result in policy inputs on the mobility and wellbeing of our ageing population.
The Centre for Isotope Research (CIO) at the University of Groningen has operated a radiocarbon (14C) dating laboratory for almost 70 years. In 2017, the CIO received a major upgrade, which involved the relocation of the laboratory to new purpose-built premises, and the installation of a MICADAS accelerator mass spectrometer. This period of transition provides an opportunity to update the laboratory’s routine procedures. This article addresses all of the processes and quality checks the CIO has in place for registering, tracking and pretreating samples for radiocarbon dating. Complementary updates relating to radioisotope measurement and uncertainty propagation will be provided in other forthcoming publications. Here, the intention is to relay all the practical information regarding the chemical preparation of samples, and to provide a concise explanation as to why each step is deemed necessary.
This article asks whether firms should contribute to the costs of procreation and parenthood. We explore two sets of arguments. First, we ask what the principle of fair play – central in parental justice debates – implies. We argue that if one defends a pro-sharing view, firms are required to shoulder part of the costs of procreation and parenthood. Second, we turn to the principle of fair equality of opportunity. We argue that compensating firms for costs they incur because their employees decide to procreate or parent may undermine some of the incentives leading to (statistical) discrimination in the workplace.
Potential routes to the formation of urea were investigated using electronic structure methods. The most likely pathways involve either the reaction of the formamide and amine radicals or involve protonated isocyanic acid as a starting point.