Verandering in crisisinterventie en acute psychiatrie: Amsterdamse consulten in 1983 en 2005.

achtergrond Sinds 1992 stijgt het aantal inbewaringstellingen (ibs'en) in Nederland opvallend. In Amsterdam is er zelfs sprake van een verdrievoudiging. Psychiatrische behandeling in de Amsterdamse klinieken dreigt gedomineerd te worden door dwang. doel Een beeld krijgen van de veranderingen in de acute psychiatrie die hebben bijgedragen aan de stijging van het aantal dwangopnames met ibs. methode Vergelijken van een cohort (n = 460) consulten verricht door de stedelijke crisisdienst in 1983 met een cohort (n = 436) consulten verricht in 2004-2005 op de volgende variabelen: werkwijze van de crisisdienst, kenmerken van de patiënten, diagnose en uitkomst van de consulten. resultaten Vergeleken met 1983 waren er in 2004-2005 meer diensten betrokken bij psychiatrische patiënten in acute situaties in het publieke domein. Het aantal patiënten dat via de politie kwam, verdubbelde. De consulten, die in 1983 uitsluitend werden gedaan op de plek waar de patiënt verbleef, werden in 2004-2005 voor 60% op het bureau van de dienst gedaan. Het aantal patiënten met een psychose in de cohort nam toe van 52,0 naar 63,3%. Er was een toename van ibs opnames (van 16,7 naar 20,0% van de interventies) en een scherpe daling van vrijwillige opnames (van 25,7 naar 7,6%). Het totale aantal opnames na een consult daalde van 42 naar 28%. conclusie De outreachende dienst met een eerstelijnskarakter van 1983 is veranderd in een gespecialiseerde psychiatrische ehbo met een bescheiden outreachende functie. De vrijwillige opname is vrijwel verdwenen bij de crisisdienst. Nader onderzoek naar de kenmerken van de consulten en naar de variabelen die een rol spelen bij het toepassen van dwang is noodzakelijk

Helical bias in supramolecular polymers accounts for different stabilities of kinetically trapped states

The idea to synthesize and self-assemble nano-graphenes with structural precision into supramolecular polymers is just one of Klaus Müllen's many pioneering contributions to the chemical sciences. To honor his impact in the field of polymer science, we here describe a study that combines experimental and computational methods in studying the stability of kinetically trapped states of supramolecular polymers. We show that the introduction of stereocenters in the sidechains allow helical supramolecular polymers based on chiral triphenylene-2,6,10-tricarboxamide monomers to escape a kinetic trap more efficiently than polymers based on their achiral analogs. Partial depolymerization of the kinetically trapped state by increasing the temperature followed by polymerization by lowering the temperature shows that monomers either polymerize on existing stacks or self-nucleate to form the thermodynamically more stable state. Chiral monomers prefer the latter more than achiral monomers.</p

Adrenal medullary hyperplasia is a precursor lesion for pheochromocytoma in MEN2 syndrome

Adrenal medullary hyperplasias (AMHs) are adrenal medullary proliferations with a size b1cm, while larger lesions are considered as pheochromocytoma (PCC). This arbitrary distinction has been proposed decades ago, although the biological relationship between AMH and PCC has never been investigated. Both lesions are frequently diagnosed in multiple endocrine neoplasia type 2 (MEN2) patients in whom they are considered as two unrelated clinical entities. In this study, we investigated the molecular relationship between AMH and PCC in MEN2 patients. Molecular aberrations of 19 AMHs and 13 PCCs from 18 MEN2 patients were determined by rearranged during transfection (RET) proto-oncogene mutation analysis and loss of heterozygosity (LOH) analysis for chromosomal regions 1p13, 1p36, 3p, and 3q, genomic areas covering commonly altered regions in RET-related PCC. Identical molecular aberrations were found in all AMHs and PCCs, at similar frequencies. LOH was seen for chromosomes 1p13 in 8 of 18 (44%), 1p36 in 9 of 15 (60%), 3p12-13 in 12 of 18 (67%), and 3q23-24 in 10 of 16 (63%) of AMHs, and for chromosome 1p13 in 13 of 13 (100%), 1p36 in 7 of 11 (64%), 3p12-13 in 4 of 11 (36%), and 3q23-24 in 11 of 12 (92%) of PCCs. Our results indicate that AMHs are not hyperplasias and, in clinical practice, should be regarded as PCCs, which has an impact on diagnosis and treatment of MEN2 patients. We therefore propose to replace the term AMH by micro-PCC to indicate adrenal medullary proliferations of less than 1cm

On the thermal sunset diagram for scalar field theories

We study the so-called `` sunset diagram'', which is one of two-loop self-energy diagrams, for scalar field theories at finite temperature. For this purpose, we first find the complete expression of the bubble diagram, the one-loop subdiagram of the sunset diagram, for arbitrary momentum. We calculate the temperature independent part and dependent part of the sunset diagram separately. For the former, we obtain the discontinuous part first and the finite continuous part next using a twice-subtracted dispersion relation. For the latter, we express it as a one-dimensional integral in terms of the bubble diagram. We also study the structure of the discontinuous part of the sunset diagram. Physical processes, which are responsible for it, are identified. Processes due to the scattering with particles in the heat bath exist only at finite temperature and generate discontinuity for arbitrary momentum, which is a remarkable feature of the two-loop diagrams at finite temperature. As an application of our result, we study the effect of the diagram on the spectral function of the sigma meson at finite temperature in the linear sigma model, which was obtained at one-loop order previously. At high temperature where the decay $\sigma\to\pi\pi$ is forbidden, sigma acquires a finite width of the order of $10 {\rm MeV}$ while within the one-loop calculation its width vanishes. At low temperature, the spectrum does not deviate much from that at one-loop order. Possible consequences with including other two-loop diagrams are discussed.Comment: 30 page

Two-point function of strangeness-carrying vector-currents in two-loop Chiral Perturbation Theory

We calculate the correlator between two external vector-currents having the quantum-numbers of a charged kaon. We give the renormalized expression to two loops in standard chiral perturbation theory in the isospin limit, which, as a physical result, is finite and scale-independent. Applications include a low energy theorem, valid at two loop order, of a flavor breaking combination of vector current correlators as well as a determination of the phenomenologically relevant finite $O(p^6)$-counterterm combination $Q_V$ by means of inverse moment finite energy sum rules. This determination is less sensitive to isospin-breaking effects than previous attempts.Comment: 24 pages, revtex, 4 figures, 2 tables, revised version, one ref. adde

Luteinizing hormone (LH)-responsive Cushing's syndrome: the demonstration of LH receptor messenger ribonucleic acid in hyperplastic adrenal cells, which respond to chorionic gonadotropin and serotonin agonists in vitro

In a substantial part of adrenal adenomas and hyperplasias from patients with Cushing's syndrome, cortisol production is controlled by the expression of aberrant hormone receptors on adrenocortical cells. We present in vivo and in vitro data of two patients with a LH-responsive Cushing's syndrome based on ACTH-independent bilateral adrenal hyperplasia. Patients 1 and 2 are women who presented with Cushing's syndrome and bilateral adrenal hyperplasia. Endocrine testing demonstrated absence of cortisol diurnal rhythm, insufficient cortisol suppression after 1 mg dexamethasone orally, and undetectable ACTH levels in both patients. Both patients were treated by laparoscopic biadrenalectomy. In in vivo testing, in patients 1 and 2, a profound cortisol rise was found after administration of GnRH [change in cortisol (Delta F), 118 and 106%, respectively], human CG (Delta F, 133 and 44%), LH (Delta F, 73 and 43%), ACTH (Delta F, 89 and 181%), and the 5-hydroxy-tryptamine receptor type 4 (5-HT(4)) agonists cisapride (Delta F, 141 and 148%) and metoclopramide (Delta F, 189 and 95%). In in vitro testing, adrenal cells from patient 2 responded, in a dose-dependent fashion, with cortisol production after exposure to human CG (Delta F, 45%), cisapride (Delta F, 68%), and metoclopramide (Delta F, 81%). ACTH induced cortisol production by cells from both patients (Delta F, 135 and 159%). In receptor studies, LH receptor mRNA was demonstrated in adrenal tissue of both patients but also in control adrenal tissue of two patients with persisting pituitary-dependent Cushing's syndrome treated by biadrenalectomy. In neither patient were mutations found in the ACTH receptor gene. LH-responsive Cushing's syndrome associated with bilateral adrenal hyperplasia may result from aberrant (or possibly increased) adrenal LH receptor expression. This variant is further characterized by adrenal responsiveness to 5-HT4 receptor agonists, po

How does the electromagnetic field couple to gravity, in particular to metric, nonmetricity, torsion, and curvature?

The coupling of the electromagnetic field to gravity is an age-old problem. Presently, there is a resurgence of interest in it, mainly for two reasons: (i) Experimental investigations are under way with ever increasing precision, be it in the laboratory or by observing outer space. (ii) One desires to test out alternatives to Einstein's gravitational theory, in particular those of a gauge-theoretical nature, like Einstein-Cartan theory or metric-affine gravity. A clean discussion requires a reflection on the foundations of electrodynamics. If one bases electrodynamics on the conservation laws of electric charge and magnetic flux, one finds Maxwell's equations expressed in terms of the excitation H=(D,H) and the field strength F=(E,B) without any intervention of the metric or the linear connection of spacetime. In other words, there is still no coupling to gravity. Only the constitutive law H= functional(F) mediates such a coupling. We discuss the different ways of how metric, nonmetricity, torsion, and curvature can come into play here. Along the way, we touch on non-local laws (Mashhoon), non-linear ones (Born-Infeld, Heisenberg-Euler, Plebanski), linear ones, including the Abelian axion (Ni), and find a method for deriving the metric from linear electrodynamics (Toupin, Schoenberg). Finally, we discuss possible non-minimal coupling schemes.Comment: Latex2e, 26 pages. Contribution to "Testing Relativistic Gravity in Space: Gyroscopes, Clocks, Interferometers ...", Proceedings of the 220th Heraeus-Seminar, 22 - 27 August 1999 in Bad Honnef, C. Laemmerzahl et al. (eds.). Springer, Berlin (2000) to be published (Revised version uses Springer Latex macros; Sec. 6 substantially rewritten; appendices removed; the list of references updated

Unraveling genetic predisposition to familial or early onset gastric cancer using germline whole-exome sequencing

Recognition of individuals with a genetic predisposition to gastric cancer (GC) enables preventive measures. However, the underlying cause of genetic susceptibility to gastric cancer remains largely unexplained. We performed germline whole-exome sequencing on leukocyte DNA of 54 patients from 53 families with genetically unexplained diffuse-type and intestinal-type GC to identify novel GC-predisposing candidate genes. As young age at diagnosis and familial clustering are hallmarks of genetic tumor susceptibility, we selected patients that were diagnosed below the age of 35, patients from families with two cases of GC at or below age 60 and patients from families with three GC cases at or below age 70. All included individuals were tested negative for germline CDH1 mutations before or during the study. Variants that were possibly deleterious according to in silico predictions were filtered using several independent approaches that were based on gene function and gene mutation burden in controls. Despite a rigorous search, no obvious candidate GC predisposition genes were identified. This negative result stresses the importance of future research studies in large, homogeneous cohorts

Renal safety of tenofovir alafenamide vs. tenofovir disoproxil fumarate: A pooled analysis of 26 clinical trials

Objective:Compared with tenofovir disoproxil fumarate (TDF), tenofovir alafenamide (TAF) has been associated with improvement in markers of renal dysfunction in individual randomized trials; however, the comparative incidence of clinically significant renal events remains unclear.Design:We used a pooled data approach to increase the person-years of drug exposure analysed, maximizing our ability to detect differences in clinically significant outcomes.Methods:We pooled clinical renal safety data across 26 treatment-naive and antiretroviral switch studies to compare the incidence of proximal renal tubulopathy and discontinuation due to renal adverse events between participants taking TAF-containing regimens vs. those taking TDF-containing regimens. We performed secondary analyses from seven large randomized studies (two treatment-naive and five switch studies) to compare incidence of renal adverse events, treatment-emergent proteinuria, changes in serum creatinine, creatinine clearance, and urinary biomarkers (albumin, beta-2-microglobulin, and retinol binding protein-to-creatinine ratios).Results:Our integrated analysis included 9322 adults and children with HIV (n = 6360 TAF, n = 2962 TDF) with exposure of 12 519 person-years to TAF and 5947 to TDF. There were no cases of proximal renal tubulopathy in participants receiving TAF vs. 10 cases in those receiving TDF (P < 0.001), and fewer individuals on TAF (3/6360) vs. TDF (14/2962) (P < 0.001) discontinued due to a renal adverse event. Participants initiating TAF-based vs. TDF-based regimens had more favourable changes in renal biomarkers through 96 weeks of therapy.Conclusion:These pooled data from 26 studies, with over 12 500 person-years of follow-up in children and adults, support the comparative renal safety of TAF over TDF