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Aggression and violent incidents are a major concern in psychiatric in-patient care. Nutritional supplementation has been found to reduce aggressive incidents and rule violations in forensic populations and children with behavioural problems.
To assess whether multivitamin, mineral and n-3 polyunsaturated fatty acid supplementation would reduce the number of aggressive incidents among long-stay psychiatric in-patients.
The trial was a pragmatic, multicentre, randomised, double-blind placebo-controlled study. Data were collected from 25 July 2016 to 29 October 2019, at eight local sites for mental healthcare in The Netherlands and Belgium. Participants were randomised (1:1) to receive 6-month treatment with either three supplements containing multivitamins, minerals and n-3 polyunsaturated fatty acid, or placebo. The primary outcome was the number of aggressive incidents, determined by the Staff Observation Aggression Scale – Revised (SOAS-R). Secondary outcomes were patient quality of life, affective symptoms and adverse events.
In total, 176 participants were randomised (supplements, n = 87; placebo, n = 89). Participants were on average 49.3 years old (s.d. 14.5) and 64.2% were male. Most patients had a psychotic disorder (60.8%). The primary outcome of SOAS-R incidents was similar in supplement (1.03 incidents per month, 95% CI 0.74–1.37) and placebo groups (0.90 incidents per month, 95% CI 0.65–1.19), with a rate ratio of 1.08 (95% CI 0.67–1.74, P = 0.75). Differential effects were not found in sensitivity analyses on the SOAS-R or on secondary outcomes.
Six months of nutritional supplementation did not reduce aggressive incidents among long-stay psychiatric in-patients.
Surface melt on the coastal Antarctic ice sheet (AIS) determines the viability of its ice shelves and the stability of the grounded ice sheet, but very few in situ melt rate estimates exist to date. Here we present a benchmark dataset of in situ surface melt rates and energy balance from nine sites in the eastern Antarctic Peninsula (AP) and coastal Dronning Maud Land (DML), East Antarctica, seven of which are located on AIS ice shelves. Meteorological time series from eight automatic and one staffed weather station (Neumayer), ranging in length from 15 months to almost 24 years, serve as input for an energy-balance model to obtain consistent surface melt rates and energy-balance results. We find that surface melt rates exhibit large temporal, spatial and process variability. Intermittent summer melt in coastal DML is primarily driven by absorption of shortwave radiation, while non-summer melt events in the eastern AP occur during föhn events that force a large downward directed turbulent flux of sensible heat. We use the in situ surface melt rate dataset to evaluate melt rates from the regional atmospheric climate model RACMO2 and validate a melt product from the QuikSCAT satellite.
Until the past half-century, all agriculture and land management was framed by local institutions strong in social capital. But neoliberal forms of development came to undermine existing structures, thus reducing sustainability and equity. The past 20 years, though, have seen the deliberate establishment of more than 8 million new social groups across the world. This restructuring and growth of rural social capital within specific territories is leading to increased productivity of agricultural and land management systems, with particular benefits for those previously excluded. Further growth would occur with more national and regional policy support.
Philosophy of technology only came into existence as a specialist branch of professional philosophy during the 1970s, although the philosophical literature during the years between 1945 and the 1970s voices an increasing preoccupation with technology. Just as the First World War led to a wave of disillusionment among intellectuals as well as the common man, so did the Second World War. This disillusionment manifested itself as pessimism, which became characteristic of several influential philosophers during the two first decades after the war. We find it echoed, for instance, in Gabriel Marcel’s The Decline of Wisdom (1954), where Marcel describes the “horror and anxiety” he felt walking through “the ruins of Vienna in 1946, or more recently in Caen, Rouen or Würzburg” (21). But the 1970s, with growing social prosperity, industrial growth, and better technologies, changed that sentiment. The development of a professional philosophy of technology has, after the 1960s, developed along two different yet familiar trajectories: one into an analytical philosophy of technology and science, the other into a Continental (or more broadly humanities-oriented) philosophy of technology (see also Thomson, this volume).
This article synthesises the results of a large international study on primary care (PC), the QUALICOPC study.
Since the Alma Ata Declaration, strengthening PC has been high on the policy agenda. PC is associated with positive health outcomes, but it is unclear how care processes and structures relate to patient experiences.
Survey data were collected during 2011–2013 from approximately 7000 PC physicians and 70 000 patients in 34, mainly European, countries. The data on the patients are linked to data on the PC physicians within each country and analysed using multilevel modelling.
Patients had more positive experiences when their PC physician provided a broader range of services. However, a broader range of services is also associated with higher rates of hospitalisations for uncontrolled diabetes, but rates of avoidable diabetes-related hospitalisations were lower in countries where patients had a continuous relationship with PC physicians. Additionally, patients with a long-term relationship with their PC physician were less likely to attend the emergency department. Capitation payment was associated with more positive patient experiences. Mono- and multidisciplinary co-location was related to improved processes in PC, but the experiences of patients visiting multidisciplinary practices were less positive. A stronger national PC structure and higher overall health care expenditures are related to more favourable patient experiences for continuity and comprehensiveness. The study also revealed inequities: patients with a migration background reported less positive experiences. People with lower incomes more often postponed PC visits for financial reasons. Comprehensive and accessible care processes are related to less postponement of care.
The study revealed room for improvement related to patient-reported experiences and highlighted the importance of core PC characteristics including a continuous doctor–patient relationship as well as a broad range of services offered by PC physicians.
This chapter lays out a conservation timeline, from past to future, for the Amsterdam version of Van Gogh's Sunflowers. It starts by considering the restoration history of the painting in order to assess its current physical state, and looks ahead to formulate an appropriate strategy for future conservation treatment and display. Due attention is paid to the two recorded episodes of restoration performed in 1927 and 1961 by the Dutch restorer, Jan Cornelis Traas. Based on physical and chemical investigation of Sunflowers we attempt to reconstruct what these former treatments (which are barely documented) entailed and consider the repercussions for the present condition of the painting. The former interventions by Traas also serve as a benchmark to reflect on current choices made, highlighting the extent to which ideas and methodologies have continued to evolve over the past century as conservation has moved further away from being a singularly craft-based activity to become an established historical and scientific discipline underpinned by ethical guidelines.
Jan Cornelis Traas (1898–1984)
As mentioned, the two main recorded interventions to the Amsterdam Sunflowers may be associated with the Dutch restorer, Jan Cornelis Traas, who treated the picture in 1927, close to the start of his career, and again in 1961, shortly before he retired. Traas was the first restorer to be appointed at the Mauritshuis in The Hague where he worked from 1931 to 1962 and treated hundreds of paintings, including iconic masterpieces such as Girl with a Pearl Earring by Johannes Vermeer. Yet despite the magnitude and importance of his restoration oeuvre, J.C. Traas (as he is usually referred to in surviving documents), has remained somewhat obscure. He is shown here in the only known surviving photograph of him at work, shortly before he retired (fig. 7.1). Unlike his illustrious contemporaries, A. Martin de Wild (1899–1969) and Helmut Ruhemann (1891–1973), for example, Traas did not publish anything, he appears to have kept no records of his work and no personal archive is known. However, the study of some newly discovered historical documents, combined with physical examination of Sunflowers and a large number of other works he treated, allows us to recover an idea of his working practices and approaches viewed within the context of his day.
Since its completion by Vincent van Gogh, the Amsterdam Sunflowers has been the subject of a complex history of interventions. Combined with the natural ageing and deterioration of the materials used by the artist, this has strongly affected the present appearance of the painting. The materials and techniques used in Sunflowers and related colour changes have been presented in chapters 4 and 5. This chapter focuses on characterizing the non-original surface layers present as well as secondary compounds arising from pigment-binder interaction in original paint components. The outcomes of this research help to reconstruct the restoration history of the painting and to understand its present condition, as a basis for optimizing future conservation treatment (as elaborated in chapter 7).
In keeping with Van Gogh's usual practice in the period, he left Sunflowers in an unvarnished state. Today, however, multiple layers of varnish are present. These have yellowed and make the painting appear highly glossy, whereas originally it presumably had the more subtle satin gloss related to pure oil paint. Conversely, some areas of the painting now look matt, since wax has been locally applied in the past.
Historical records provide sparse information regarding the surface layers added during earlier campaigns of treatment (see chapter 7). We know that the painting was varnished in 1927 by the conservator Jan Cornelis Traas, as part of a broader restoration and structural (lining) treatment. Remains of paper tape on the tacking margins of the painting are believed to date from this period (see chapter 7, p. 184). Further documents record that in 1961, Traas worked on the painting again. However, as there is no known account of what this treatment entailed, it remained in question whether Traas removed the 1927 varnish and/or applied new surface coating layers instead. Furthermore, in the late twentieth century, wax was applied in certain areas, used to matt down the glossy varnish and/or impregnate and consolidate the ground.
This chapter describes the outcome of the technical examinations of the Amsterdam Sunflowers, characterizing the surface layers present and assessing the history of application as revealed by their stratigraphy and chemical composition.
West Antarctic climate and surface mass balance (SMB) records are sparse. To fill this gap, regional atmospheric climate modelling is useful, providing that such models are employed at sufficiently high horizontal resolution and coupled with a snow model. Here we present the results of a high-resolution (5.5 km) regional atmospheric climate model (RACMO2) simulation of coastal West Antarctica for the period 1979–2015. We evaluate the results with available in situ weather observations, remote-sensing estimates of surface melt, and SMB estimates derived from radar and firn cores. Moreover, results are compared with those from a lower-resolution version, to assess the added value of the resolution. The high-resolution model resolves small-scale climate variability invoked by topography, such as the relatively warm conditions over ice-shelf grounding zones, and local wind speed accelerations. Surface melt and SMB are well reproduced by RACMO2. This dataset will prove useful for picking ice core locations, converting elevation changes to mass changes, for driving ocean, ice-sheet and coupled models, and for attributing changes in the West Antarctic Ice Sheet and shelves to changes in atmospheric forcing.
Mass changes of polar ice sheets have an important societal impact, because they affect global sea level. Estimating the current mass budget of ice sheets is equivalent to determining the balance between surface mass gain through precipitation and outflow across the grounding line. For the Antarctic ice sheet, grounding line outflow is governed by oceanic processes and outlet glacier dynamics. In this study, we compute the mass budget of major outlet glaciers in the eastern Dronning Maud Land sector of the Antarctic ice sheet using the input/output method. Input is given by recent surface accumulation estimates (SMB) of the whole drainage basin. The outflow at the grounding line is determined from the radar data of a recent airborne survey and satellite-based velocities using a flow model of combined plug flow and simple shear. This approach is an improvement on previous studies, as the ice thickness is measured, rather than being estimated from hydrostatic equilibrium. In line with the general thickening of the ice sheet over this sector, we estimate the regional mass balance in this area at 3.15 ± 8.23 Gt a−1 according to the most recent SMB model results.
In this paper, we use formal asymptotic arguments to understand the stability properties of equivariant solutions to the Landau–Lifshitz–Gilbert model for ferromagnets. We also analyse both the harmonic map heatflow and Schrödinger map flow limit cases. All asymptotic results are verified by detailed numerical experiments, as well as a robust topological argument. The key result of this paper is that blowup solutions to these problems are co-dimension one and hence both unstable and non-generic.
Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with better care quality. Accordingly, we conducted a cross-sectional survey of nursing home directors of care in Vancouver Coastal Health, a large health region in British Columbia. The survey addressed staffing levels and organization, physician access, end-of-life care, and factors influencing facility-to-hospital transfers. Many of the modifiable organizational characteristics associated in the literature with potentially avoidable hospital transfers and better care quality are present in nursing homes in British Columbia. However, their presence is not universal, and some features, especially the organization of physician care and end-of-life planning and services, are particularly lacking.
Biodiversity is the variability among living organisms, from genes to the biosphere. The value of biodiversity is multifold, from preserving the integrity of the biosphere as a whole, to providing food and medicines, to spiritual and aesthetic well-being.
One of the major drivers of biodiversity loss in Europe is atmospheric deposition of reactive nitrogen (Nr).
This chapter focuses on Nr impacts on European plant species diversity; in particular, the number and abundance of different species in a given area, and the presence of characteristic species of sensitive ecosystems.
We summarise both the scientific and the policy aspects of Nr impacts on diversity and identify, using a range of evidence, the most vulnerable ecosystems and regions in Europe.
Key findings/state of knowledge
Reactive nitrogen impacts vegetation diversity through direct foliar damage, eutrophication, acidification, and susceptibility to secondary stress.
Species and communities most sensitive to chronically elevated Nr deposition are those that are adapted to low nutrient levels, or are poorly buffered against acidification. Grassland, heathland, peatland, forest, and arctic/montane ecosystems are recognised as vulnerable habitats in Europe; other habitats may be vulnerable but are still poorly studied.
It is not yet clear if different wet-deposited forms of Nr (e.g. nitrate, NO3− versus ammonium, NH4+) have different effects on biodiversity. However, gaseous ammonia (NH3) can be particularly harmful to vegetation, especially lower plants, through direct foliar damage.
Observations of atmospheric reactive nitrogen (Nr) deposition are severely restricted in spatial extent and type. The chain of processes leading to atmospheric deposition emissions, atmospheric dispersion, chemical transformation and eventual loss from the atmosphere is extremely complex and therefore currently, observations can only address part of this chain.
Modelling provides a way of estimating atmospheric transport and deposition of Nr at the European scale. A description of the different model types is provided.
Current deposition estimates from models are compared with observations from European air chemistry monitoring networks.
The main focus of the chapter is at the European scale; however, both local variability and and intercontinental Nr transfers are also addressed.
Key findings/state of knowledge
Atmospheric deposition is a major input of Nr for European terrestrial and freshwater ecosystems as well as coastal sea areas.
Models are key tools to integrate our understanding of atmospheric chemistry and transport, and are essential for estimating the spatial distribution of deposition, and to support the formulation of air pollution control strategies.
Our knowledge of the reliability of models for deposition estimates is, however, limited, since we have so few observational constraints on many key parameters.
Total Nr deposition estimates cannot be directly assessed because of a lack of measurements, especially of the Nr dry deposition component. Differences among European regional models can be significant, however, e.g. 30% in some areas, and substantially more than this for specific locations.