Osing Kids and the banners of Blambangan Ethnolinguistic identity and the regional past as ambient themes in an East Javanese town

On the basis of the theoretical notions of discursive ambience and ambient discourse, this article examines the recent history of language and ethnicity in Banyuwangi in the far east of Java. Over the last three decades (with roots going back to the 1920s and earlier) a redefinition of the language and culture of the “autochthonous” inhabitants of Banyuwangi has been occurring. Their status and constitution have been changing from a variety of Javanese into an autonomous language and ethnicity, called, after the name given to the language or dialect, Osing. At the same time, an idyllic and heroic picture of the regional past is being constructed and maintained. Prominent among the factors and agencies involved in these two ongoing processes is popular media culture. The regency of Banyuwangi and especially its capital (also named Banyuwangi) are being cast – albeit sporadically and incidentally and sometimes controversially – as an Osing region. At the centre of this historical process, people publicly render themselves – also sporadically and temporarily – Banyuwanginese by listening to and especially by singing, in karaoke-style, a genre of pop music with Osing lyrics and musical characteristics perceived as local

Marjolin's ulcers in south eastern Nigeria - A 15 year review at the close of the last millennium

Objective: Marjolin's ulcers first reported by Celsius more than 2000 years ago still have a poor prognosis with poorly understood evolution. Thought to be rare, it has been reported to be commoner in sub-Saharan Africa including southern Nigeria, with a more aggressive natural history. Thus an attempt is made to review the pattern of presentation of marjolin's ulcers, and challenges of management in South Eastern Nigeria as at the close of the last millennium.Method: Case records of patients managed for marjolin 's ulcers at the National Orthopaedic Hospital, Enugu, Nigeria from January 1980 to December 1994 were reviewed. The data obtained were analyzed using descriptive statistics.Results: Seventy (70) patients were managed for marjolin's ulcers in the period under review, constituting 27%of primary skin cancers managed in that period. The mean age of the patients was 44.9 years with a male: female ratio of 2:1 Thirty seven (53%) arose from an active chronic ulcer while 33(47%) originated from previous scars with an average interval of onset of 22.1yrs. The post-burn scars had a shorter interval of onset of 11.6yrs, compared to 29.8 yrs for the nonburn scars.  The lower limbs were most commonly involved (71%), while the trunk was least involved (3%). Squamous cell carcinoma was the histologic type in 66 (95%) patients. Fifty two (74%) patients commenced treatment with amputation being the commonest form of treatment offered. Follow up was poor as only 3% had follow up for up to 5 years or until death.Conclusion: This study has shown that about 50% of Marjolin's ulcers arose from unstable scars and were therefore potentially preventable. Improved access to appropriate healthcare as captured in the millennium development goals should reduce the incidence and improve outcome.Keywords: Marjolin's ulcer Pattern; Management Challenges; Southeastern Nigeria; Millennium Revie

Visual hallucinations, misidentification and reduplication of time:a sense of distorted reality due to a cerebral metastasis

Wij beschrijven een patiënte van 66 jaar zonder psychiatrische voorgeschiedenis die zich meldde met een atypisch psychotisch toestandsbeeld dat grotendeels voldeed aan de kenmerken van het fregolisyndroom (misidentificatie van personen). Daarnaast had patiënte reduplicatie van tijd, scenische hallucinaties en waanwaarnemingen. De oorzaak bleek een hersenmetastase vanuit een primaire longtumor. We beschrijven (aanvullende) diagnostiek en bespreken hoe te differentiëren tussen een organische en functionele psychose, daarnaast beschrijven we de psychiatrische behandeling van patiënte. Ten slotte geven we mogelijke pathofysiologische verklaringen voor het optreden en het verminderen van de symptomen bij deze patiënte.We describe a 66-year-old female patient with no prior psychiatric history who presented with an unusual psychotic state, largely in accordance with Fregoli syndrome (misidentification of people). Further, the patient suffered from reduplication of time, scenic hallucinations and psychotic perceptions. Symptoms were the result of a brain metastasis originating from a lung carcinoma. We describe the performed (additional) diagnostics and discuss how to differentiate between organic and functional psychosis, as well as the given psychiatric treatment. Finally, potential pathophysiological explanations are discussed that might explain the (reduction of) symptoms in the patient

Individual and common patterns in the order of symptom improvement during outpatient treatment for major depression

BACKGROUND: Research so far provided few clues on the order in which depressive symptoms typically remit during treatment. This study examined which depressive symptoms improve first, and whether symptoms changed before, simultaneous with, or after the core symptoms of depression (i.e., sad mood, loss of pleasure, and loss of interest). METHODS: Participants were 176 patients with Major Depressive Disorder (MDD) receiving outpatient treatment (a combination of pharmacotherapy and psychological interventions) for depression. Participants filled out the Inventory of Depressive Symptomatology - Self Report (IDS-SR) for 16 to 20 consecutive weeks. For each symptom, the timing of onset of a persistent improvement was determined for each single-subject separately. RESULTS: Which symptoms improved first differed markedly across patients. The core depression symptoms improved 1.5 to 2 times more often before (48% - 60%) than after (19% -28%) depressive cognitions ('view of myself' and 'view of the future'), anxiety symptoms ('feeling irritable' and 'feeling anxious / tense') and vegetative symptoms ('loss of energy', 'slowed down', and 'physical energy'). Only improvements in suicidal thoughts were more likely to occur before (46% - 48%) than after (29%) improvements in the depression core symptoms. LIMITATIONS: Not all 'core depression-non-core symptom' combinations could be tested because some symptoms did not improve in a sufficient number of patients. CONCLUSIONS: Which improvements mark the start of symptom remission differed between patients. Improvements in the core depression symptoms 'sad mood', 'loss of interest', and 'loss of pleasure' were more likely to occur before than after improvements in non-core symptoms

Development of an effective outsourcing strategy for toxicological studies in the chemical industry

The chemical industry has been put under considerable time pressure by the European Community Regulation REACH (Registration, Evaluation, and Authorization of Chemicals). The work outlined here has been developed at the BASF SE’s Experimental Toxicology and Ecology Unit with the objective of promoting a faster reaction to the testing demand generated by the new legislation. A considerable increase in forecasted demand for tests has created the necessity to increase the Toxicology Unit’s outsourcing activities. The first goal was to optimize the selection and management process of Contract Research Organizations (CROs), so that toxicological studies can be performed with minimal risk while maximizing quality and cost advantage. A second objective was to develop performance measurement system in form of a balanced scorecard to evaluate contracting efficiency by monitoring major drivers in the outsourcing process to ensure the alignment between strategic objectives and actual performance.<br

Monitoring of somatic parameters at outpatient departments for mood and anxiety disorders

INTRODUCTION: Somatic complications account for the majority of the 13-30 years shortened life expectancy in psychiatric patients compared to the general population. The study aim was to assess to which extent patients visiting outpatient departments for mood and anxiety disorders were monitored for relevant somatic comorbidities and (adverse) effects of psychotropic drugs-more specifically a) metabolic parameters, b) lithium safety and c) ECGs-during their treatment. METHODS: We performed a retrospective clinical records review and cross-sectional analysis to assess the extent of somatic monitoring at four outpatient departments for mood and anxiety disorders in The Netherlands. We consecutively recruited adult patients visiting a participating outpatient department between March and November 2014. The primary outcome was percentage of patients without monitoring measurements. Secondary outcomes were number of measurements per parameter per patient per year and time from start of treatment to first measurement. RESULTS: We included 324 outpatients, of whom 60.2% were female. Most patients were treated for depressive disorders (39.8%), anxiety disorders (16.7%) or bipolar or related disorders (11.7%) and 198 patients (61.1%) used at least one psychotropic drug. For 186 patients (57.4%), no monitoring records were recorded (median treatment period 7.3 months, range 0-55.6). The median number of measurements per parameter per year since the start of outpatient treatment for patients with monitoring measurements was 0.31 (range 0.0-12.9). The median time to first monitoring measurement per parameter for patients with monitoring measurements was 3.8 months (range 0.0-50.7). DISCUSSION: Somatic monitoring in outpatients with mood and anxiety disorders is not routine clinical practice. Monitoring practices need to be improved to prevent psychiatric outpatients from undetected somatic complications