Search

This study demonstrates the use of digital image processing for the spatial pattern recognition and characterisation of Ni concentrations in topsoil in Europe. Moving average smoothing was applied to the TIN-interpolated grid model to suppress small irregularities. Digital image processing was applied then to the grid. Several NE-SW, E-W and NW-SE oriented features were revealed at the continental scale. The dominant NE-SW linear features follow the Variscan and Alpine orogenies. The highest variability zones are in the Alps and the Balkans where mafic and ultramafic rocks outcrop. A single major E-W oriented north-facing feature runs along the last continental glaciation zone. This zone also coincides with a series of local maxima in Ni concentration along the glaciofluvial deposits. The NW-SE elongated features are located in the Pyrenees, northern Italy, Hellas and Fennoscandia. This study demonstrates the advantages of digital image processing analysis in identifying and characterising spatial geochemical patterns unseen before on conventional colour-surface maps.

Agricultural soil (Ap-horizon, 0–20 cm) samples were collected from 33 European countries as part of the GEMAS (GEochemical Mapping of Agricultural and grazing land Soil) soil-mapping project. The Mg data derived from total concentrations (XRF) and two acid digestion methods, aqua regia (AR) and Mobile Metal Ion (MMI®), were used to provide an overview of its spatial distribution in soil at the continental-scale. Magnesium is one of the most abundant elements in the Earth's crust and essential nutrient for plants and animals and its presence in soil is, therefore, important for soil quality evaluation. In this study, the geochemical behaviour of Mg in European agricultural soil was investigated in relation to a variety of soil parent materials, climatic zones, and landscapes. The chemical composition of soil reflects mostly the primary mineralogy of the source bedrock, and the superimposed effects of pre- and post-depositional chemical weathering, controlled by element mobility and formation of secondary phases such as clays. Low Mg concentrations in agricultural soil occur in regions with quartz-rich glacial sediments (Poland, Baltic States, N. Germany), and in soil developed on quartz-rich sandstone parent materials (e.g., central Sweden). High Mg concentrations occur in soil developed over mafic lithologies such as ophiolite belts and in carbonate-rich regions, including karst areas. The maximum extent of the last glaciation is well defined by a Mg concentration break, which is marked by low Mg concentrations in Fennoscandia and north-central Europe, and high Mg concentrations in Mediterranean region. Lithology of parent materials seems to play a key role in the Mg nutritional status of agricultural soil at the European scale. Influence from agricultural practice and use of fertilisers appears to be subordinate. Comparison of the continental-scale spatial distribution of Mg in agricultural soil by using the results from three analytical methods (XRF, AR and MMI®) provides complementary information about Mg mobility and its residence time in soil. Thus, allowing evaluation of soil weathering grade and impact of land use exploitation.

Agricultural soil (Ap-horizon, 0–20 cm) samples were collected from a large part of Europe (33 countries, 5.6 million km2) as part of the GEMAS (GEochemical Mapping of Agricultural and grazing land Soil) soil mapping project. The soil data have been used to provide a general view of element mobility and source rocks at the continental scale, either by reference to average crustal abundances or to normalised patterns of element mobility during weathering processes. The survey area includes a diverse group of soil parent materials with varying geological history, a wide range of climate zones, and landscapes. Total concentrations of Rb, Ga, and Cs in European soil were determined by XRF (X-ray fluorescence spectrometry). In addition, hot aqua regia available element concentrations were analysed by inductively coupled plasma-mass spectrometry ICP-MS. Their spatial distribution patterns are shown in geochemical maps. The spatial distribution of Rb, Ga and Cs in Ap soil is quite comparable for the aqua regia and XRF results. The Cs spatial pattern reflects best the large difference between trace element concentrations in northern Europe with predominantly low concentrations and southern Europe with approximately two times higher values. The maximum extent of the last glaciation is visible as a clear concentration break on the map. Lithology of the underlying bedrock is inferred as the major source of geochemical anomalies. In search for characterising the soil parent material and degree of weathering, the soil data were examined for Ga and Cs using two methods. First, the estimated degree of extractability DEi of an element in a sample was calculated by dividing aqua regia available concentrations by the total concentrations obtained by XRF analysis for Al, Na, Ca, K, Rb, Ga and Cs. The different DEi were investigated for 10 geological parent material subgroups (alkaline rocks, granite, calcareous rocks, basalt-mafic rocks, unclassified lithologies, Precambrian granitic gneiss bedrocks, loess, organic soils, schist and soil developed on coarse-grained sandy deposits). The role of clay as main carrier of Ga and Cs phases was inferred for soils developed on several types of bedrock such as granite, gneiss and alkaline rocks. Additionally, an affinity of Cs for loess and carbonate rocks has been observed.

Introduction: One of the most detrimental factors influencing development is growing up in poverty. According to the World Health Organization, extreme poverty is the leading cause of mortality and morbidity. Unfortunately, some children encounter more unhealthy and potentially detrimental circumstances than others, increasing their risk for later health problems. Poor perinatal outcomes are more often observed in deprived neighborhoods, with both more perinatal mortality and morbidity (prematurity and small for gestational age) in these neighborhoods. Additionally, growing up in families with a lower socio-economic status exposes children to more unsafe environments, making them more at risk for insecure attachment to their parents, behavioral problems, addiction, mental illnesses, deficits in cognitive development and domestic violence. In sum, children growing up in deprivation are more unhealthy, as a consequence of an increased risk of unfavorable perinatal outcomes in combination with growing up in a multidimensional unforgiving environment. We assume that the poor health status of these children is reflected in higher healthcare expenses, since they require more medical care than their healthy peers. Here, we aim to investigate the effects of deprivation on healthcare costs of young children in the Netherlands. Methods: This is a cross-sectional study, using data from several national registries. All children in the Netherlands, aged zero to three years old in 2014, were included. Healthcare costs included all expenses covered by obligatory basic health insurance. Deprivation was studied using monthly household income per 1000 euro’s and neighborhood deprivation scores. The final linear regression model was built for healthcare costs as function of both deprivation variables, perinatal morbidity, ethnicity, a 3-way interaction of household income, perinatal morbidity and ethnicity (including subsequent 2-way interactions) and the 2-way interaction of deprivation index and perinatal morbidity. Results: A total of 583,625 children were included in the analyses. Both household income (β = -4.72, 95% CI [-7.22, -2.23]) and deprivation score (β = 19.31, 95% CI [11.11, 27.51]) were significantly related to healthcare costs. Discussion and conclusion: This research shows that growing up with a lower household income and a higher neighborhood deprivation is significantly associated with higher healthcare costs in early life. These findings support the assumption that children growing up in deprivation have a poorer health status, resulting in (health) inequities already in early childhood. This inequity is particularly detrimental since the gap between poor and rich is widening, not only regarding income disparity, but also in the case of health inequality. Limitations: This research excluded children who died during, or soon after pregnancy, since these children have limited healthcare costs. Nevertheless, this outcome may be of even greater societal relevance when targeting the inequality gap. Suggestions for future research: Future research should focus attention on interventions targeting vulnerable population, before, during and after pregnancy, in order to gain highly necessary knowledge on how to provide an optimal start in life for all children. Lessons learned: More attention should be focused on marginalized populations in order to break through the intergenerational cycle of poor health.

IntroductionResearch focusing on the associations between non-medical determinants and unfavourable perinatal health outcomes is increasing. Despite increasing knowledge on this theme, it still remains unclear to what extent social, environmental and lifestyle factors contribute to these unfavourable outcomes. Therefore, we aim to provide a systematic review, preferably with meta-analysis, in order to provide insight into the associations between non-medical determinants and perinatal mortality, preterm birth and being small for gestational age (SGA).Methods and analysisObservational studies performed in European countries studying the associations between non-medical determinants and unfavourable perinatal health outcomes will be included. Primary outcomes of interest are perinatal mortality, preterm birth and SGA. To retrieve potential eligible articles, a systematic literature search was performed in the following online databases on 5 October 2018: MEDLINE, Embase, Web of Science, Cochrane and Google Scholar. Additionally, a reference list check and citation search will be performed. Data of the included articles will be extracted using a standardised and piloted data extraction form. Risk of bias will be assessed using the Newcastle-Ottawa Scale. The study selection and data extraction process will be performed by two reviewers independently. Disagreements will be resolved through discussion with a third reviewer. The pooled effects will be calculated separately for each association found between one of the outcome measures and the non-medical determinants using a random effects model. Heterogeneity of the studies will be assessed using the I2statistic.Ethics and disseminationNo ethical approval is necessary for a systematic review with meta-analysis. The findings will be published in a peer-reviewed journal.PROSPERO registration numberCRD42018056105.

Item does not contain fulltext BACKGROUND: Laparoscopic pancreatoduodenectomy may improve postoperative recovery compared with open pancreatoduodenectomy. However, there are concerns that the extensive learning curve of this complex procedure could increase the risk of complications. We aimed to assess whether laparoscopic pancreatoduodenectomy could reduce time to functional recovery compared with open pancreatoduodenectomy. METHODS: This multicentre, patient-blinded, parallel-group, randomised controlled phase 2/3 trial was performed in four centres in the Netherlands that each do 20 or more pancreatoduodenectomies annually; surgeons had to have completed a dedicated training programme for laparoscopic pancreatoduodenectomy and have done 20 or more laparoscopic pancreatoduodenectomies before trial participation. Patients with a benign, premalignant, or malignant indication for pancreatoduodenectomy, without signs of vascular involvement, were randomly assigned (1:1) to undergo either laparoscopic or open pancreatoduodenectomy using a central web-based system. Randomisation was stratified for annual case volume and preoperative estimated risk of pancreatic fistula. Patients were blinded to treatment allocation. Analysis was done according to the intention-to-treat principle. The main objective of the phase 2 part of the trial was to assess the safety of laparoscopic pancreatoduodenectomy (complications and mortality), and the primary outcome of phase 3 was time to functional recovery in days, defined as all of the following: adequate pain control with only oral analgesia; independent mobility; ability to maintain more than 50% of the daily required caloric intake; no need for intravenous fluid administration; and no signs of infection (temperature

We present Sr-87/Sr-86 isotope ratios for similar to 1200 selected soil samples, collected by the GEMAS consortium from grazing (Gr) and agricultural (Ap) soils in Europe with the aim to better understand the strontium isotope distribution in the bioavailable fraction of the top-soil and its potential for provenancing applications. Spatial analysis shows that there is a clear distinction between coastal (100 km) samples in their variance and that this variance is mirrored in the sodium concentration, suggesting an important but highly variable contribution from seaspray. We present two Sr-87/Sr-86 maps at 25 km x 25 km scale: one based solely on the measured data using a classical kriging approach and one based on a Random Forest model using complementary GEMAS data to predict the strontium isotope composition at the remaining 3000+ GEMAS sampling locations, including appropriate uncertainty assessment. Using a forensic Bayesian likelihood ratio approach, a tool was developed in R to create provenancing likelihood ratio maps. The maps delineate areas of high and low likelihood and allow investigators to direct their resources to areas of interest. For actual forensic case work either the measured or the modelled data can be used as reference data for the overall distribution of Sr-87/Sr-86 values in Europe. (C) 2019 Elsevier B.V. All tights reserved.

The demand for ‘high-tech’ element resources (e.g., rare earth elements, lithium, platinum group elements) has increased with their continued consumption in developed countries and the emergence of developing economies. To provide a sound knowledge base for future generations, it is necessary to identify the spatial distribution of critical elements at a broad-scale, and to delineate areas for follow-up surveys. Subsequently, this knowledge can be used to study possible environmental consequences of the increased use of these resources. In this paper, three critical industrial elements (Sb, W, Li) from low-sampling density geochemical mapping at the continental-scale are presented. The geochemical distribution and spatial patterns have been obtained from agricultural soil samples (Ap-horizon, 0–20 cm; N = 2108 samples) collected at a density of 1 site per 2500 km2 and analysed by ICP-MS after a hot aqua regia digestion as part of the GEMAS (GEochemical Mapping of Agricultural and grazing land Soil) soil-mapping project in 33 European countries. Most of the geochemical maps show exclusively natural background element concentrations with minor, or without, anthropogenic influence. The maximum extent of the last glaciation is marked as a discrete element concentration break, and a distinct difference occurs in element concentration levels between the soil of northern and southern Europe, most likely an effect of soil genesis, age and weathering. The Sb, W and Li concentrations in soil provide a general overview of element spatial distribution in relation to complexity of the underlying bedrock and element mobility in the surface environment at the continental-scale. The chemical composition of agricultural soil represents largely the primary mineralogy of the source bedrock, the effects of pre- and post-depositional chemical weathering, formation of secondary products, such as clays, and element mobility, either by leaching or mineral sorting. Observed geochemical patterns of Li, W and Sb can be often linked with known mineralisation as recorded in the ProMine Mineral Database, where elements in question occur either as main or secondary resources. Anthropogenic impact has only been identified locally, predominantly in the vicinity of large urban agglomerations. Unexplained high element concentrations may potentially indicate new sources for high-tech elements and should be investigated at a more detailed scale.

IntroductionSocial vulnerability is known to be related to ill health. When a pregnant woman is socially vulnerable, the ill health does not only affect herself, but also the health and development of her (unborn) child. To optimise care for highly vulnerable pregnant women, in Rotterdam, a holistic programme was developed in close collaboration between the university hospital, the local government and a non-profit organisation. This programme aims to organise social and medical care from pregnancy until the second birthday of the child, while targeting adult and child issues simultaneously. In 2014, a pilot in the municipality of Rotterdam demonstrated the significance of this holistic approach for highly vulnerable pregnant women. In the ‘Mothers of Rotterdam’ study, we aim to prospectively evaluate the effectiveness of the holistic approach, referred to as targeted social care.Methods and analysisThe Mothers of Rotterdam study is a pragmatic prospective cohort study planning to include 1200 highly vulnerable pregnant women for the comparison between targeted social care and care as usual. Effectiveness will be compared on the following outcomes: (1) child development (does the child show adaptive development at year 1?) and (2) maternal mental health (is maternal distress reduced at the end of the social care programme?). Propensity scores will be used to correct for baseline differences between both social care programmes.Ethics and disseminationThe prospective cohort study was approved by the Erasmus Medical Centre Ethics Committee (ref. no. MEC-2016–012) and the first results of the study are expected to be available in the second half of 2019 through publication in peer-reviewed international journals.Trial registration numberNTR6271; Pre-results.

Agricultural soil (Ap-horizon, 0–20 cm) samples were collected in Europe (33 countries, 5.6 million km2) as part of the GEMAS (GEochemical Mapping of Agricultural and grazing land Soil) soil-mapping project. The GEMAS survey area includes diverse groups of soil parent materials with varying geological history, a wide range of climate zones, and landscapes. The soil data have been used to provide a general view of U and Th mobility at the continental scale, using aqua regia and MMI® extractions. The U-Th distribution pattern is closely related to the compositional variation of the geological bedrock on which the soil is developed and human impact on the environment has not concealed these genuine geochemical features. Results from both extraction methods (aqua regia and MMI®) used in this study support this general picture. Ternary plots of several soil parameters have been used to evaluate chemical weathering trends. In the aqua regia extraction, some relative Th enrichment-U loss is related to the influence of alkaline and schist bedrocks, due to weathering processes. Whereas U enrichment-Th loss characterizes soils developed on alkaline and mafic bedrock end-members on one hand and calcareous rock, with a concomitant Sc depletion (used as proxy for mafic lithologies), on the other hand. This reflects weathering processes sensu latu, and their role in U retention in related soils. Contrary to that, the large U enrichment relative to Th in the MMI® extraction and the absence of end-member parent material influence explaining the enrichment indicates that lithology is not the cause of such enrichment. Comparison of U and Th to the soil geological parent material evidenced i) higher capability of U to be weathered in soils and higher resistance of Th to weathering processes and its enrichment in soils; and, ii) the MMI® extraction results show a greater affinity of U than Th for the bearing phases like clays and organic matter. The comparison of geological units with U anomalies in agricultural soil at the country scale (France) enables better understanding of U sources in the surficial environment and can be a useful tool in risk assessments.

A reliable overview of measured concentrations of TC, TN and TS, TOC/TN ratios, and their regional distribution patterns in agricultural soil at the continental scale and based on measured data has been missing - despite much previous work on local and the European scales. Detection and mapping of natural (ambient) background element concentrations and variability in Europe was the focus of this work. While total C and S data had been presented in the GEMAS atlas already, this work delivers more precise (lower limit of determination) and fully quantitative data, and for the first time high-quality TN data. Samples were collected from the uppermost 20 cm of ploughed soil (Ap horizon) at 2108 sites with an even sampling density of one site per 2500 km2 for one individual land-use class (agricultural) across Europe (33 countries). Laboratory-independent quality control from sampling to analysis guaranteed very good data reliability and accuracy. Total carbon concentrations ranged from 0.37 to 46.3 wt% (median: 2.20 wt%) and TOC from 0.40 to 46.0 wt% (median: 1.80 wt%). Total nitrogen ranged from 0.018 to 2.64 wt% (median: 0.169 wt%) and TS from 0.008 to 9.74 wt% (median: 0.034 wt%), all with large variations in most countries. The TOC/TN ratios ranged from 1.8 to 252 (median: 10.1), with the largest variation in Spain and the smallest in some eastern European countries. Distinct and repetitive patterns emerge at the European scale, reflecting mostly geogenic and longer-term climatic influence responsible for the spatial distribution of TC, TN and TS. Different processes become visible at the continental scale when examining TC, TN and TS concentrations in agricultural soil Europe-wide. This facilitates large-scale land-use management and allows specific areas (subregional to local) to be identified that may require more detailed research.

The GEMAS (geochemical mapping of agricultural soil) project collected 2108 Ap horizon soil samples from regularly ploughed fields in 33 European countries, covering 5.6 million km(2). The

Epidemiological studies have shown an association between physical activity and sleep, but it is unclear what the temporal order of this association is and whether it differs for depressed patients and healthy controls. Using a multiple repeated observations design, 27 depressed and 27 pair-matched nondepressed participants completed daily measurements of subjective sleep quality and duration during 30 consecutive days while an accelerometer continuously registered their physical activity. Changes in sleep duration, not quality, predicted next-day changes in physical activity (B = -0.21, p

Assessing performance of mental health services (MHS) providers merely by their outcomes is insufficient. Process factors, such as treatment cost or duration, should also be considered in a meaningful and thorough analysis of quality of care. The present study aims to examine various performance indicators based on treatment outcome and two process factors: duration and cost of treatment. Data of patients with depression or anxiety from eight Dutch MHS providers were used. Treatment outcome was operationalized as case mix corrected pre-to-posttreatment change scores and as reliable change (improved) and clinical significant change (recovered). Duration and cost were corrected for case mix differences as well. Three performance indicators were calculated and compared: outcome as such, duration per outcome, and cost per outcome. The results showed that performance indicators, which also take process variability into account, reveal larger differences between MHS providers than mere outcome. We recommend to use the three performance indicators in a complementary way. Average pre-to-posttreatment change allows for a simple and straightforward ranking of MHS providers. Duration per outcome informs patients on how MHS providers compare in how quickly symptomatic relief is achieved. Cost per outcome informs MHS providers on how they compare regarding the efficiency of their care. The substantial variation among MHS providers in outcome, treatment duration and cost calls for further exploration of its causes, dissemination of best practices, and continuous quality improvement.

International audience; Agricultural soil (Ap-horizon, 0–20 cm) and grazing land soil (Gr-horizon, 0–10 cm) samples were collected from a large part of Europe (33 countries, 5.6 million km2) as part of the GEMAS (GEochemical Mapping of Agricultural and grazing land Soil) soil mapping project. GEMAS soil data have been used to provide a general view of element mobility and source rocks at the continental scale, either by reference to average crustal abundances or to normalized patterns of element mobility during weathering processes. The survey area includes a diverse group of soil parent materials with varying geological history, a wide range of climate zones, and landscapes.The concentrations of Ge in European soil were determined by ICP-MS after an aqua extraction, and their spatial distribution patterns generated by means of a GIS software.The median values of Ge and its spatial distribution in Ap and Gr soils are almost the same (0.037 vs. 0.034 mg/kg, respectively). The majority of Ge anomalies is related to the type of soil parent material, namely lithology of the bedrock and minor influence of soil parameters such as pH, TOC and clay content. Metallogenic belts with sulphide mineralisation provide the primary source of Ge in soil in several regions in Europe, e.g. in Scandinavia, Germany, France, Spain and Balkan countries.Comparison with total Ge concentrations obtained from the Baltic Soil Survey shows that aqua regia is a very selective method with rather low-efficiency and cannot provide a complete explanation for Ge geochemical behaviour in soil. Additionally, large differences in Ge distribution are to be expected when different soil depth horizons are analysed.

The international guideline for complex posttraumatic stress disorder (ptsd) from the International Society for Traumatic Stress Studies (istss) recommends treatment in phases, starting with stabilisation treatment. Different forms of stabilisation training have been developed the past few years, one being short-term group stabilisation training.br/AIM: To map out the effects of the short-term group training.br/METHOD: The research implemented a pre-post design. The training consisted of five group sessions. Questionnaires (bsi, OQ 45 and svl-15) were completed both prior to and after the training. Four domains were assessed: psychosymptomatology in general, depressive symptoms, problems with interpersonal functioning and ptsd-related symptoms. The effect of the training was calculated by paired t-tests.br/RESULTS: The questionnaires of the 47 participants who had completed the training were analysed. No significant decrease was observed during the stabilisation training concerning the symptoms of the four evaluated domains.br/CONCLUSION: Contrary our expectations, a short-term group-based stabilisation training does not seem to have added value when treating patients with complex ptsd. The results correspond with a recent trend in which the effectiveness of other stabilising methods is questioned. Alternative treatment options are discussed.

Sleep and physical activity are related, but the direction of this relationship is unclear and it is not known whether the direction differs in depressed and non-depressed persons.To study the bidirectional relationship between physical activity and sleep in daily life by making repeated measurements in depressed and non-depressed people.Every day for 30 consecutive days each depressed (N = 27) and non-depressed (N = 27) participant in our study had to complete an electronic questionnaire relating to subjective sleep quality and sleep duration and were required to wear an accelerometer that recorded physical activity.Multi-level analysis showed that an increase in subjective sleep duration resulted in a decrease in physical activity. The differences between individuals with regard to the direction and strength of this relationship were significant. Changes in physical activity did not predict changes in sleep quality or sleep duration. We did not find any differences in the relationships for depressed and non-depressed participants.Change in sleep duration predicts change in physical activity, although there was significant heterogeneity in the results for individuals. Our findings underline the importance of further research and of the development of interventions that are tailored to the precise needs of the individual patient.

Partial least squares regression (PLSR) models, using mid-infrared (MIR) diffuse reflectance Fourier-transformed (DRIFT) spectra, were used to predict distribution coefficient (Kd) values for selected added soluble metal cations (Ag(+), Co(2+), Cu(2+), Mn(2+), Ni(2+), Pb(2+), Sn(4+), and Zn(2+)) in 4813 soils of the Geochemical Mapping of Agricultural Soils (GEMAS) program. For the development of the PLSR models, approximately 500 representative soils were selected based on the spectra, and Kd values were determined using a single-point soluble metal or radioactive isotope spike. The optimum models, using a combination of MIR-DRIFT spectra and soil pH, resulted in good predictions for log Kd+1 for Co, Mn, Ni, Pb, and Zn (R(2) ≥ 0.83) but poor predictions for Ag, Cu, and Sn (R(2) 0.50). These models were applied to the prediction of log Kd+1 values in the remaining 4313 unknown soils. The PLSR models provide a rapid and inexpensive tool to assess the mobility and potential availability of selected metallic cations in European soils. Further model development and validation will be needed to enable the prediction of log K(d+1) values in soils worldwide with different soil types and properties not covered in the existing model.

The authors' aim was to develop rapid and inexpensive regression models for the prediction of partitioning coefficients (Kd), defined as the ratio of the total or surface-bound metal/metalloid concentration of the solid phase to the total concentration in the solution phase. Values of Kd were measured for boric acid (B[OH]3(0)) and selected added soluble oxoanions: molybdate (MoO4(2-)), antimonate (Sb[OH](6-)), selenate (SeO4(2-)), tellurate (TeO4(2-)) and vanadate (VO4(3-)). Models were developed using approximately 500 spectrally representative soils of the Geochemical Mapping of Agricultural Soils of Europe (GEMAS) program. These calibration soils represented the major properties of the entire 4813 soils of the GEMAS project. Multiple linear regression (MLR) from soil properties, partial least-squares regression (PLSR) using mid-infrared diffuse reflectance Fourier-transformed (DRIFT) spectra, and models using DRIFT spectra plus analytical pH values (DRIFT + pH), were compared with predicted log K(d + 1) values. Apart from selenate (R(2) = 0.43), the DRIFT + pH calibrations resulted in marginally better models to predict log K(d + 1) values (R(2) = 0.62-0.79), compared with those from PSLR-DRIFT (R(2) = 0.61-0.72) and MLR (R(2) = 0.54-0.79). The DRIFT + pH calibrations were applied to the prediction of log K(d + 1) values in the remaining 4313 soils. An example map of predicted log K(d + 1) values for added soluble MoO4(2-) in soils across Europe is presented. The DRIFT + pH PLSR models provided a rapid and inexpensive tool to assess the risk of mobility and potential availability of boric acid and selected oxoanions in European soils. For these models to be used in the prediction of log K(d + 1) values in soils globally, additional research will be needed to determine if soil variability is accounted on the calibration.

Drop-out is a complex problem in mental health care and in STEPPS. Research has revealed a variety of predicting factors and has produced contradictory results.To investigate whether the information available at the start of STEPPS can pinpoint predictors of drop-out.The ROM data for 150 patients were used to test the link between the following factors: age, gender, education, employment, substance abuse, anxiety, hostility, interpersonal relations, responsibility and social concordance with drop-out. The method used for testing was logistic regression analysis.Factors that contributed significantly to the prediction of drop-out were gender and employment status. These factors made up 16% of the explained variation (R2 Nagelkerkes) in drop-out. Gender was the strongest predictive factor. Concerning the other factors, no differences were found between groups (drop-out and non-dropouts).In its present form STEPPS does not suit a large number of the male participants. Drop-out during STEPPS is hard to predict on the basis of ROM-questionnaires. Future research should focus on preconditions and marginal conditions that influence patients to complete their training.

Optimal nutrition for patients in the intensive care unit has been proposed to be the provision of energy as determined by indirect calorimetry and the provision of protein of at least 1.2 g/kg.Prospective observational cohort study in a mixed medical-surgical intensive care unit in an academic hospital. In total, 886 consecutive mechanically ventilated patients were included. Nutrition was guided by indirect calorimetry and protein provision of at least 1.2 g/kg. Cumulative intakes were calculated for the period of mechanical ventilation. Cox regression was used to analyze the effect of protein + energy target achieved or energy target achieved versus neither target achieved on 28-day mortality, with adjustments for sex, age, body mass index, Acute Physiology and Chronic Health Evaluation II, diagnosis, and hyperglycemic index.Patients' mean age was 63 ± 16 years; body mass index, 26 ± 6; and Acute Physiology and Chronic Health Evaluation II, 23 ± 8. For neither target, energy target, and protein + energy target, energy intake was 75% ± 15%, 96% ± 5%, and 99% ± 5% of target, and protein intake was 72% ± 20%, 89% ± 10%, and 112% ± 12% of target, respectively. Hazard ratios (95% confidence interval) for energy target and protein + energy target were 0.83 (0.67-1.01) and 0.47 (0.31-0.73) for 28-day mortality.Optimal nutritional therapy in mechanically ventilated, critically ill patients, defined as protein and energy targets reached, is associated with a decrease in 28-day mortality by 50%, whereas only reaching energy targets is not associated with a reduction in mortality.

Introduction: Evidence shows that low socioeconomic status SES is related to decreased mental health of the individual. Exposure to determinants such as low income, unemployment, being a single parent, and living in a deprived neighbourhood increases levels of chronic stress. This results in diminishing overall resources to cope with stressful situations, making them more vulnerable for unhealthy and unfavourable behaviour, and a decreased health status of the individual. These negative effects do not only create a vulnerability in the individual for poor health, but effect the next generation already during pregnancy. Therefore, policies targeting highly vulnerable pregnant women potentially have far-reaching effects. Within the Netherlands, Rotterdam has the highest percentage of children growing up in poverty 25%, in a family living on welfare 19%, with a low parental level of education 20%, and with one or both parents being unemployed 10%. Furthermore, 57% of the children in Rotterdam grow up in a deprived neighbourhood. Description of policy context, objective and targeted population: In the Netherlands, social care is usually carried out by a community social care team: a multidisciplinary team of professionals located in the neighbourhood of their clients. Based on the needs of the client, care is either focused on adult issues such as financial problems or problems regarding children and adolescents such as underperformance at school. This strict separation of the social care in adult- and child-care is suboptimal in the care of highly vulnerable pregnant women, since impact of risk and adversity is not limited to one generation and can simultaneously affect both parents and children. Within Rotterdam, the Erasmus Medical Centre, the municipality, and a non-profit organization are combining their expertise to improve the psycho-social situation of highly vulnerable pregnant women. Ultimately, this will result in a healthy development of the unborn child. This targeted social care integrates medical and social care in a long-term and intensive support program. This support focusses on all issues a women and her child can encounter during pregnancy and after giving birth: health, housing, employment, social functioning, mother-child interaction and child development. In the “Mothers of Rotterdam” study, we aim to prospectively evaluate the effectiveness of the holistic approach compared to regular care provided by the community social care teams. Highlights and transferability: This program promotes societal valorisation of knowledge through valuable collaboration between academics, government and a non-profit organization by supporting the healthy development of future generations. Due to the pragmatic character of the study, randomization of participants is not possible, but is determined by a natural experiment. Therefore, this ecologically valid study design allows for results directly generalizable to the actual population, although it increases the risk of true effects being masked by unmeasured confounders. Conclusion: This study will provide unique insights into a notoriously difficult to reach population of highly vulnerable pregnant women, their problems and potential care pathways for these problems.

Introduction: Within the Netherlands, large differences in perinatal outcomes are observed between groups with different ethnicities and socioeconomic status. Pregnant women with multiple social problems are more at risk of poor perinatal outcomes. This is also true for the municipality of Rotterdam, thus a holistic program was developed to optimize care for highly vulnerable pregnant women. The Mothers of Rotterdam MoR is an unique program that combines social and medical care from pregnancy until the second birthday of the child. MoR has a central registration point where socialcare can be requested for pregnant women living in Rotterdam who are social vulnerable. Registration is easily accessible and pregnant women can also apply for care themselves. An intake by a social professional in the home environment is scheduled with each pregnant woman to assess the amount and intensity of their problems. This study aims to determine how problems, registered at referral, represent those determined by a social professional after the home visit. Methods: A prospective cohort study containing 128 participants, who were referred to MoR between 01-01-2016 and 30-05-2017, was conducted to investigate the differences in problems indicated at referral and after the home visit. The referring party filled out a checklist including potential social- and medical problems. This checklist consisted of 47 problems divided over 8 domains. The social professional of MoR filled out the same checklist after the first home visit. The problem scores were constructed by counting the number of problems indicated on the checklist. A Wilcoxon signed rank test was used to test the differences between the problems scored on both checklists. Results: 176 pregnant women received care from MoR. 13 of them 7.4% were self-referred pregnant women. From 128 pregnant women both checklists were available for evaluation. 95 pregnant women 74% were referred by a medical professional and 33 pregnant women 26% were referred by a social professional. The social professionals scored a significantly higher number of problems p=0.004 after the first home visit than the referring party. Discussion: The setting in which the checklist is completed, behind a desk versus in the home environment, contributes to the assessment of the problems. A medical professional has less knowledge of social problems and besides their medical responsibility, they have less time to pay attention to this. Conclusions: Social professionals detect more problems after a home visit than medical and social professional at referral. Lessons learned: A home visit by a social professional is of added value in the identification of all social problems that are present in our population of socially vulnerable pregnant women. Limitations: The information about the checklist at registration is missing from the self-referral pregnant women and therefore not analyzed. suggestions for future research: We suggest to validate the items on the checklist and to use prediction modeling to optimize the checklist. This can help a medical or social professional to make a quick and accurate assessment of the problems.

Tendon injuries are notorious for their slow and functionally inferior healing. Intratendinous application of platelet-rich plasma (PRP) has been reported to stimulate the repair process of tendon injuries, but there is little conclusive evidence for its effectiveness. A placebo-controlled experimental trial was performed to test the hypothesis that a single intratendinous PRP treatment enhances the quality of tendon repair, as evidenced by improved biochemical, biomechanical, and histological tissue properties. In six horses, tendon lesions were created surgically in the Superficial Digital Flexor Tendons (SDFT) of both front limbs, one of which was treated with PRP and the other with saline. After 24 weeks, the tendons were harvested for biochemical, biomechanical, and histological evaluations. Collagen, glycosaminoglycan, and DNA content (cellularity) was higher in PRP-treated tendons (p = 0.039, 0.038, and 0.034, respectively). The repair tissue in the PRP group showed a higher strength at failure (p = 0.021) and Elastic Modulus (p = 0.019). Histologically, PRP-treated tendons featured better organization of the collagen network (p = 0.031) and signs of increased metabolic activity (p = 0.031). It was concluded that PRP increases metabolic activity and seems to advance maturation of repair tissue over nontreated experimentally induced tendon lesions, which suggests that PRP might be beneficial in the treatment of clinical tendon injuries. (C) 2009 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 28:211-217, 2010

The final stages of cervical ripening and parturition resemble an inflammatory process. Although the role of cytokines in both spontaneous and experimentally induced parturitions has been described in several small laboratory animals and humans, the involvement of pro-inflammatory and regulatory cytokines in physiologic parturition in cows has not been determined. In this study, the cytokine expression profiles were assessed in bovine cervical tissue at several stages of pregnancy and at parturition. Serial biopsy samples of the cervix were obtained from 10 cows on day 185 and day 275 of pregnancy (which was on average 5.4 days before parturition) and at parturition. Messenger RNA expression levels of interleukin (IL)-1beta, IL-6, IL-8, IL-10 and tumour necrosis factor (TNF)alpha were determined using real-time polymerase chain reaction and the number of neutrophils and eosinophils was estimated by Luna and Sirius Red staining. At parturition, IL-8 expression had increased 430-fold (p < 0.001) when compared with that of the day 185 of pregnancy, large numbers of neutrophils had invaded the cervix while eosinophils remained scarce, IL-1beta had increased eightfold (p < 0.05) and IL-6 had not changed significantly. Additionally, IL-10 was increased by 10-fold (p < 0.001) and TNFalpha decreased by 57% (p < 0.05) when compared with that of the day 185 of pregnancy. The large increase in expression of IL-8, enabling the influx of neutrophils, is indicative of its important role in the final stage of cervical ripening and at parturition. As previous studies have shown that neutrophils excrete matrix metalloproteinases (MMP), this might contribute to softening of the cervix. In contrast, the only slightly increased levels of IL-1, steady concentrations of IL-6 and decreased TNFalpha, the potential consequences of increased IL-10 expression, indicate that final cervical of cows in ripening at term parturition is an inflammatory process influenced by regulatory cytokines.

Background & aims: Optimal nutritional therapy for energy and protein in critically ill, mechanically ventilated patients can be defined as: providing calories matched with the measured energy expenditure and delivery of protein in an amount of 1.2-1.5 g/kg pre-admission weight/day. Several enteral nutritional products are available with different energy/protein proportions. We developed an algorithm to choose the nutritional formula that combines optimal energy and protein supply for individual patients. Methods: The energy and protein values of three nutritional formulas were used together with an aimed provision of 1.2-1.5 g protein/kg/day to construct a nomogram. From that, an algorithm followed, which was tested retrospectively in 203 mechanically ventilated patients with a normal BMI and known values for energy expenditure and weight. Results: In the nomogram cut-off points for energy/weight ratios were: 19.0-23.8 for a normal energy/high protein formula, 23.8-29.8 for a high energy/high protein formula and 30-37.5 for the normal energy/normal protein formula. The algorithm uses energy expenditure/body weight ratio of the patients to choose one of the three formulas. This resulted in an adequate provision of protein in 93% of the patients. Conclusion: The algorithm leads to provision of adequate amounts of protein and energy in the majority of critically ill, mechanically ventilated patients.

Objective The aim of this study was to investigate to what extent atypical antipsychotics, conventional antipsychotics and anticholinergics are prescribed simultaneously in daily clinical practice in Europe. Method A pharmaco-epidemiological study was carried out in which hospital pharmacists from 45 hospitals in Belgium, Denmark, France, Germany, The Netherlands and Scotland participated. Prescription data for 2,725 patients (mainly inpatients) who had been using an atypical antipsychotic for more than 6 weeks were analysed. Main outcome measure The frequencies of simultaneous prescription of atypical antipsychotics with other antipsychotics and/or anticholinergics. Results In this sample of patients with an atypical antipsychotic 42.1% was prescribed another antipsychotic (24.1% if low-potent antipsychotics were not included in the analysis) and 30.1% was prescribed an anticholinergic. In total 47.1% of patients were prescribed an atypical antipsychotic without any other antipsychotic or anticholinergic. Conclusion It is common practice to prescribe a combination of atypical antipsychotics and conventional antipsychotics and/or anticholinergics. This suggests that monotherapy involving an atypical antipsychotic is not considered to be an adequate treatment for a substantial number of patients in clinical practice.

Partial least squares regression (PLSR) models, using mid-infrared (MIR) diffuse reflectance Fourier-transformed (DRIFT) spectra, were used to predict distribution coefficient (K-d) values for selected added soluble metal cations (Ag+, Co2+, Cu2+, Mn2+, Ni2+, Pb2+, Sn4+, and Zn2+) in 4813 soils of the Geochemical Mapping of Agricultural Soils (GEMAS) program. For the development of the PLSR models, approximately 500 representative soils were selected based on the spectra, and K-d values were determined using a single-point soluble metal or radioactive isotope spike. The optimum models, using a combination of MIR-DRIFT spectra and soil pH, resulted in good predictions for log Kd+1 for Co, Mn, Ni, Pb, and Zn (R-2 0.83) but poor predictions for Ag, Cu, and Sn (R-2

The complete genome sequence of a single nucleocapsid nucleopolyhedrovirus recently isolated from Chrysodeixis chalcites (ChchNPV) was determined. The viral genome has a size of 149 622 bp and an overall G+C content of 39·1 mol%. The sequence contains 151 predicted open reading frames (ORFs) with a minimal size of 50 codons. The similarity of these ORFs with those of other completely sequenced baculoviruses was calculated using a newly developed database, named gecco. Phylogenetic analysis of the whole genome confirmed the evolutionary relationship of ChchNPV with group II NPVs, as did the absence of the NPV group I-specific gp64 gene. It is the first group II NPV to encode proliferating cell nuclear antigen. Most noteworthy is the presence of two ORFs encoding a class II cyclobutane pyrimidine dimer DNA photolyase. These two ORFs share only 45 % amino acid identity and have different promoter motifs. Twenty-two additional unique baculovirus genes were identified, including a gene encoding a novel putative RING finger protein with a possible homologue in poxviruses.

We introduce a method using the rheology of concentrated solutions to differentiate sensitively between nonbranched and branched architecture polymer melts. By modeling the concentration dependent shift in zero-shear viscosity using molecular tube theory for melt rheology, it is feasible to quantify the degree of long chain branching as well as the distribution of sizes of such branches, providing the class of branched material is known. The technique detects branched chains with the order of one entanglement length and greater. We apply the technique, already validated against monodisperse controlled-architecture polymers [D. R. Daniels et al. Rheol. Acta 40, 403 (2001)], to a series of industrially produced metallocene-catalyzed polyethylenes with an octene comonomer and two low density polyethylenes, diluted by the short chain alkane squalane. The dilution method compares favorably with direct solution methods, and holds promise of much greater sensitivity.