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Compulsory admission is commonly regarded as necessary and justified for patients whose psychiatric condition represents a severe danger to themselves and others. However, while studies on compulsory admissions have reported on various clinical and social outcomes, little research has focused specifically on dangerousness, which in many countries is the core reason for compulsory admission.
To study changes in dangerousness over time in adult psychiatric patients admitted by compulsory court order, and to relate these changes to these patients' demographic and clinical characteristics.
In this explorative prospective observational cohort study of adult psychiatric patients admitted by compulsory court order, demographic and clinical data were collected at baseline. At baseline and at 6 and 12 month follow-up, dangerousness was assessed using the Dangerousness Inventory, an instrument based on the eight types of dangerousness towards self or others specified in Dutch legislation on compulsory admissions. We used descriptive statistics and logistic regression to analyse the data.
We included 174 participants with a court-ordered compulsory admission. At baseline, the most common dangerousness criterion was inability to cope in society. Any type of severe or very severe dangerousness decreased from 86.2% at baseline to 36.2% at 6 months and to 28.7% at 12 months. Being homeless at baseline was the only variable which was significantly associated with persistently high levels of dangerousness.
Dangerousness decreased in about two-thirds of the patients after court-ordered compulsory admission. It persisted, however, in a substantial minority (approximately one-third).
It is well known that deterministic two-dimensional marine ice sheets can only be stable if the grounding line is positioned at a sufficiently steep, downward sloping bedrock. When bedrock conditions favour instabilities, multiple stable ice sheet profiles may occur. Here, we employ continuation techniques to examine the sensitivity of a two-dimensional marine ice sheet to stochastic noise representing short time scale variability, either in the accumulation rate or in the sea level height. We find that in unique regimes, the position of the grounding line is most sensitive to noise in the accumulation rate and can explain excursions observed in field measurements. In the multiple equilibrium regime, there is a strong asymmetry in transition probabilities between the different ice sheet states, with a strong preference to switch to the branch with a steeper bedrock slope.
Orbit calculations were done in a rotating triaxial system with a density distribution in accordance with recent observations of spiral galaxies. A search was made for simple closed orbits which are tilted with respect to the plane of the galaxy. A family of stable prograde tilted orbits was found which can explain warps as stationary phenomena.
Significant efforts have been made to identify risk factors associated with suicide. However, the evidence suggests that risk categorisation may be of limited value, or worse, potentially harmful, confusing clinical thinking. We argue instead for a shift in focus towards real engagement with the individual patient, their specific problems and circumstances.
Co-ossified pygal and caudal vertebrae in Late Cretaceous mosasaurs from the southeast Netherlands, northeast Belgium, and North America are compared with lumbar and caudal vertebrae from fossil and extant whales. Both infectious spondylitis and idiopathic vertebral hyperostosis afflicted these marine tetrapods. The causes of the infectious disease and of the idiopathic disease are similar in the compared life forms. The location of idiopathic hyperostosis along the vertebral column implicates axial locomotion in mosasaurs, as in whales.
We report the discovery of a new species of marine reptile, a mosasaur, from the Upper Cretaceous (Maastrichtian) of The Netherlands. Prognathodon saturator sp. nov. is represented by an almost complete skull and much of the postcranial skeleton, and is one of the largest mosasaurs discovered to date. The stout skull and extremely massive jaws are more powerfully built than in any other known mosasaur. Bite marks, the partial disarticulation and scattering of the skeleton, and the presence of associated teeth of Squalicorax and Plicatoscyllium suggest extensive scavenging by sharks.
This work was part of the EU RobustMilk project. In this work package, we have focused on two aspects of robustness, micro- and macro-environmental sensitivity and applied these to somatic cell count (SCC), one aspect of milk quality. We showed that it is possible to combine both categorical and continuous descriptions of the environment in one analysis of genotype by environment interaction. We also developed a method to estimate genetic variation in residual variance and applied it to both simulated and a large field data set of dairy cattle. We showed that it is possible to estimate genetic variation in both micro- and macro-environmental sensitivity in the same data, but that there is a need for good data structure. In a dairy cattle example, this would mean at least 100 bulls with at least 100 daughters each. We also developed methods for improved genetic evaluation of SCC. We estimated genetic variance for some alternative SCC traits, both in an experimental herd data and in field data. Most of them were highly correlated with subclinical mastitis (>0.9) and clinical mastitis (0.7 to 0.8), and were also highly correlated with each other. We studied whether the fact that animals in different herds are differentially exposed to mastitis pathogens could be a reason for the low heritabilities for mastitis, but did not find strong evidence for that. We also created a new model to estimate breeding values not only for the probability of getting mastitis but also for recovering from it. In a progeny-testing situation, this approach resulted in accuracies of 0.75 and 0.4 for these two traits, respectively, which means that it is possible to also select for cows that recover more quickly if they get mastitis.
Forensic psychiatry aims to reduce recidivism and makes use of risk
assessment tools to achieve this goal. Various studies have reported on
the predictive qualities of these instruments, but it remains unclear
whether their use is associated with actual prevention of recidivism in
To test whether an intervention combining risk assessment and shared care
planning is associated with a reduction in violent and criminal
A cluster randomised controlled trial (Netherlands Trial Register number
NTR1042) was conducted in three outpatient forensic psychiatric clinics.
The intervention comprised risk assessment with the Short Term Assessment
of Risk and Treatability (START) and a shared care planning protocol
formulated according to shared decision-making principles. The control
group received usual care. The outcome consisted of the proportion of
clients with violent or criminal incidents at follow-up.
In total 58 case managers and 632 of their clients were included, in the
intervention group (n=310), 65% received the
intervention at least once. Findings showed a general treatment effect
(22% of clients with an incident at baseline v. 15% at
follow-up, P<0.01) but no significant difference
between the two treatment conditions (odds ratio (OR)=1.46, 95% CI
0.89-2.44, P = 0.15).
Although risk assessment is common practice in forensic psychiatry, our
results indicate that the primary goal of preventing recidivism was not
reached through risk assessment embedded in shared decision-making.
According to the stress sensitization hypothesis, prior exposure to extreme stressors may lead to increased responsiveness to subsequent stressors. It is unclear whether disaster exposure is associated with stress sensitization and, if so, whether this effect is lasting or temporary. This study aimed to investigate the occurrence and duration of stress sensitization prospectively following a major disaster.
Residents affected by a fireworks disaster (n=1083) participated in surveys 2–3 weeks (T1), 18–20 months (T2) and almost 4 years (T3) after the disaster. Participants reported disaster exposure, including direct exposure, injury and damage to their home at T1, and also stressful life events (SLEs) at T2 and T3. Feelings of anxiety and depression, concentration difficulty, hostility, sleep disturbance, and intrusion and avoidance of disaster-related memories were used as indicators of distress.
Residents whose home was completely destroyed responded with greater distress to SLEs reported 18–20 months following the disaster than residents whose home was less damaged. There were no differences in stress responsiveness almost 4 years after the disaster.
During the first years after a disaster, stress sensitization may occur in disaster survivors who experienced extreme disaster exposure. Stress sensitization may explain the persistence or progression of distress over time following extreme stressor exposure.
The yeast S. cereviseae represents the first eukaryotic organism whose genome has been entirely sequenced as a result of the Human Genome Project(1). In this report we demonstrate the good agreement between an experimental high resolution melting curve of total nuclear S. cereviseae DNA and the theoretical melting calculated for the complete yeast DNA genome (12,067,277 bp: Saccharomyces Genome Database) by the statistical thermodynamics program MELTSIM, parameterized for long DNA sequences(2,3). The experimental and theoretical melting curves are both fairly symmetrical and possess nearly identical Tm values. Calculated melting of coding and flanking DNA regions indicates that flanking DNAs are more (A+T)-rich than coding sequences and account for the earliest melting DNA. Calculated melting curves of the 16 individual yeast chromosomes are very similar and with few exceptions exhibit symmetric melting curves. MELTSIM was also used to calculate a theoretical denaturation map of Chromosome III DNA. The agreement between MELTSIM calculated and experimental melting data demonstrates our ability to accurately simulate long DNA sequence melting in complex eukaryotic genomes, whose sequences are becoming increasingly available for study in public databases. This has important consequences for the understanding of sequence dependent energetic properties of DNA in their biological sequence context and also for their potential use in biomaterials applications.
We used the micropipet aspiration technique for a study of biomembrane adhesion. Adhesion was caused by contact site A, a highly specific cell adhesion molecule, reconstituted in lipid vesicles of DOPC with 5 %(mol/mol) DOPE-PEG2000. We found adhesion and subsequent receptor aggregation in the contact zone. Additionally, electrostatic modulation of membrane adhesion was studied. Whereas addition of the negatively charged lipid SOPS to the lecithin (SOPC) host membrane suppressed adhesion due to electrostatic repulsion, a positively charged lipid (DOTAP) was surprisingly ineffective. This might be due to either phase separation of the mixture or DOTAP changing other membrane properties as bending stiffness and the Hamaker constant.
The ATP-dependent motility of the kinesin-related non claret disjunctional (ncd) mechanoenzyme was observed in an in vitro bead motility assay using optical tweezers in combination with a new two-dimensional displacement detection method. The detection technique is based on observing the far-field interference pattern formed in the back focal plane (BFP) of the microscope condenser by the illuminating laser focus and the light scattered from the trapped dielectric bead. The ability to observe the two-dimensional motion, with high temporal and spatial resolution, and in a manner largely independent of position in the microscope field-of-view, is the particular advantage of this detection method. In the assay, a fusion protein (GST-N195) of truncated ncd and glutathione-Stransferase was adsorbed to silica beads and the axial and lateral motions of the beads along the microtubule surface were observed. The average axial velocity of the ncd coated beads was 230 ± 30 nm/s (± std. dev.). Spectral analysis of bead motion showed an increase in viscous drag near the surface. Furthermore, we also found that any elastic constraints of the moving motors are much smaller than the constraints due to binding in the presence of the non-hydrolyzable nucleotide adenylylimido-diphosphate (AMP-PNP).
We monitor the effect of transversal membrane asymmetry on the morphology of giant uni-lamellar vesicles in sugar and polymer solutions. The shapes of fluid lipid vesicles are governed by the bending elasticity of their membrane which is characterized by the bending modulus and the spontaneous curvature of the bilayer. We present a recently developed technique for the measurement of the spontaneous curvature using quantitative phase contrast microscopy. Different mechanisms for elastic membrane asymmetry and the role of the bending energy concept for the morphology of cellular organelles are discussed.
We present a general strategy for the efficient assembly of organic molecules directly onto the silicon surface via Si-N and Si-O linkages. This is achieved from the reaction between an amine or an alcohol functional group and a chlorinated Si surface. The resulting organic monolayers are thermally stable. These methods are applicable for the assembly of a variety of functional organic molecules in both vacuum environment and solution phases.
Interventions to improve adherence to treatment in people with psychotic disorders have produced inconclusive results. We developed a new treatment, treatment adherence therapy (TAT), whose intervention modules are tailored to the reasons for an individual's non-adherence.
To examine the effectiveness of TAT with regard to service engagement and medication adherence in out-patients with psychotic disorders who engage poorly.
Randomised controlled study of TAT v. treatment as usual (TAU) in 109 out-patients. Most outcome measurements were performed by masked assessors. We used intention-to-treat multivariate analyses (Dutch Trial Registry: NTR1159).
Treatment adherence therapy v. TAU significantly benefited service engagement (Cohen's d = 0.48) and medication adherence (Cohen's d = 0.43). Results remained significant at 6-month follow-up for medication adherence. Near-significant effects were also found regarding involuntary readmissions (1.9% v. 11.8%, P = 0.053). Symptoms and quality of life did not improve.
Treatment adherence therapy helps improve engagement and adherence, and may prevent involuntary admission.
Intensive selection for high milk yield in dairy cows has raised production levels substantially but at the cost of reduced fertility, which manifests in different ways including reduced expression of oestrous behaviour. The genomic regulation of oestrous behaviour in bovines remains largely unknown. Here, we aimed to identify and study those genes that were associated with oestrous behaviour among genes expressed in the bovine anterior pituitary either at the start of oestrous cycle or at the mid-cycle (around day 12 of cycle), or regardless of the phase of cycle. Oestrous behaviour was recorded in each of 28 primiparous cows from 30 days in milk onwards till the day of their sacrifice (between 77 and 139 days in milk) and quantified as heat scores. An average heat score value was calculated for each cow from heat scores observed during consecutive oestrous cycles excluding the cycle on the day of sacrifice. A microarray experiment was designed to measure gene expression in the anterior pituitary of these cows, 14 of which were sacrificed at the start of oestrous cycle (day 0) and 14 around day 12 of cycle (day 12). Gene expression was modelled as a function of the orthogonally transformed average heat score values using a Bayesian hierarchical mixed model on data from day 0 cows alone (analysis 1), day 12 cows alone (analysis 2) and the combined data from day 0 and day 12 cows (analysis 3). Genes whose expression patterns showed significant linear or non-linear relationships with average heat scores were identified in all three analyses (177, 142 and 118 genes, respectively). Gene ontology terms enriched among genes identified in analysis 1 revealed processes associated with expression of oestrous behaviour whereas the terms enriched among genes identified in analysis 2 and 3 were general processes which may facilitate proper expression of oestrous behaviour at the subsequent oestrus. Studying these genes will help to improve our understanding of the genomic regulation of oestrous behaviour, ultimately leading to better management strategies and tools to improve or monitor reproductive performance in bovines.
Livestock-associated MRSA has been found in various animals, livestock farmers and retail meat. This study aimed to determine the prevalence and determinants of nasal MRSA carriage in pig slaughterhouse workers. Three large pig slaughterhouses in The Netherlands were studied in 2008 using human and environmental samples. The overall prevalence of nasal MRSA carriage in employees of pig slaughterhouses was 5·6% (14/249) (95% CI 3·4–9·2) and working with live pigs was the single most important factor for being MRSA positive (OR 38·2, P<0·0001). At the start of the day MRSA was only found in environmental samples from the lairages (10/12), whereas at the end of the day MRSA was found in the lairages (11/12), the dirty (5/12) and clean (3/12) areas and green offal (1/3). The MRSA status of the environmental samples correlated well with the MRSA status of humans working in these sections (r=0·75). In conclusion, a high prevalence of nasal MRSA carriage was found in pig-slaughterhouse workers, and working with live pigs is the most important risk factor. Exact transmission routes from animals to humans remain to be elucidated in order to enable application of targeted preventive measures.
To determine methicillin-resistant Staphylococcus aureus (MRSA) carriage in poultry and slaughterhouse personnel, 40 Dutch broiler flocks, in six slaughterhouses and 466 personnel were sampled. Of the employees, 26 were positive (5·6%), indicating a higher risk of exposure when compared to the general Dutch population (0·1%). This risk was significantly higher for personnel having contact with live animals (5·2%) – especially hanging broilers on the slaughterline (20·0%) – than for all other personnel (1·9%). Conventional electric stunning conferred a significantly higher risk of MRSA carriage for employees than CO2 stunning (9·7% vs. 2·0%). A total of 405 broilers were sampled upon their arrival at the slaughterhouse, of which 6·9% were positive. These broilers originated from 40 Dutch slaughter flocks of which 35·0% were positive. MRSA contamination in the different compartments of slaughterhouses increased during the production day, from 8% to 35%. Of the 119 MRSA isolates, predominantly livestock-associated MRSA ST398 was found, although 27·7% belonged to ST9 (spa type t1430). There is an increased risk of MRSA carriage in personnel working at broiler slaughterhouses, particularly those having contact with live animals.
In breeding programs, robustness of animals and uniformity of end product can be improved by exploiting genetic variation in residual variance. Residual variance can be defined as environmental variance after accounting for all identifiable effects. The aims of this study were to estimate genetic variance in residual variance of body weight, and to estimate genetic correlations between body weight itself and its residual variance and between female and male residual variance for broilers. The data sets comprised 26 972 female and 24 407 male body weight records. Variance components were estimated with ASREML. Estimates of the heritability of residual variance were in the range 0.029 (s.e. = 0.003) to 0.047 (s.e. = 0.004). The genetic coefficients of variation were high, between 0.35 and 0.57. Heritabilities were higher in females than in males. Accounting for heterogeneous residual variance increased the heritabilities for body weight as well. Genetic correlations between body weight and its residual variance were −0.41 (s.e. = 0.032) and −0.45 (s.e. = 0.040), respectively, in females and males. The genetic correlation between female and male residual variance was 0.11 (s.e. = 0.089), indicating that female and male residual variance are different traits. Results indicate good opportunities to simultaneously increase the mean and improve uniformity of body weight of broilers by selection.