Exploring Continuity of Care in Patients with Alcohol Use Disorders Using Time-Variant Measures

Background/Aims: We used time-variant measures of continuity of care to study fluctuations in long-term treatment use by patients with alcohol-related disorders. Methods: Data on service use were extracted from the Psychiatric Case Register for the Rotterdam Region, The Netherlands. Continuity measures were calculated for each day over a 2-year observation period. Repeated measures analysis was used to identify factors that influence continuity of care over time. Results: Continuity of care was higher for patients with more severe disorders. Though quantity of care was high for patients with long problem history during the first year of treatment, it decreased strongly in the second year. The intervals between treatment contacts were shorter for women, especially young ones, than for men. Conclusion: Timevariant measures showed differences in continuity of care that would not have been revealed if more aggregated measures of service use had been used

Resource use efficiency and environmental performance of biofuel cropping systems

Dit proefschrift heeft tot doel om de productie-ecologische duurzaamheid te analyseren van een aantal productieketens voor biobrandstoffen die zoveel mogelijk de wereldwijde verscheidenheid aan gewassen, biofysische en overige omstandigheden weerspiegelen. Productie-ecologische duurzaamheid maakt deel uit van de milieudimensie van duurzaamheid; voor ons specifieke doel hebben we dit deelgebied gedefinieerd middels een set duurzaamheidsindicatoren die betrekking hebben op de efficiëntie waarmee schaarse grondstoffen gebruikt worden, op bodemkwaliteit, netto energieproductie en broeikasgasemissies. Een tweede doel van dit proefschrift is het formuleren van een algemene methodiek die duurzaamheidsanalyses van productieketens voor biobrandstoffen mogelijk maakt, die helpt bij het ontwikkelen van zulke systemen met een minimum aan landgebruiksverandering en mogelijk een basis zou kunnen vormen voor het certificeren van de duurzaamheid ervan

Symposia on Plant (Protein) Phosphorylation.

From September 14-16, 2011 the twelfth symposium on Plant Protein Phosphorylation was held in Tübingen, Germany. The topic is as broad as the name suggests and covers all aspects of this important means of protein modification in plants. I have had the pleasure of attending the 2007 and the 2011 symposia. The interesting concept behind these meetings is to hear about the same biochemical mechanism operative in a multitude of experimental systems. The meetings are quite informal and present an excellent mix ranging from technology to biochemical experience and novel findings and tools.The two-and-a-half-day program was divided into five double sessions: biotic interactions, hormone signaling, abiotic interactions, Mitogen Activated Protein Kinase (MAPK) and Ca++ pathways and phosphoproteomics. It was hosted by the Zentrum für Molekularbiologie der Pflanzen (ZMBP) and the organizing committee chaired by Klaus Harter

Duurzaamheid van ethanolbieten : het toetsingskader toegepast

In deze studie is een poging gedaan om in een concrete bio-energieketen en aan de hand van concrete datasets, het toetsingskader toe te passen waar mogelijk. Gekozen is voor ethanolproductie op basis van suikerbieten waarbij het accent is gelegd op het agronomische deel van de keten. De duurzaamheid van de suikerbietethanolketen, zoals hier berekend, scoort goed op de criteria die in ogenschouw zijn genomen. De reductie van broeikasgasemissie voldoet aan de norm van 30%. Een intensievere teelt van suikerbieten heeft geen betekenisvolle invloed op de C-voorraad in de bodem noch op het milieu. De energiebalans is positief, met een netto-energieopbrengst van gemiddeld 76 GJ per ha gedurende 3 jaren op 2 proefbedrijven in Nederland. Hierbij moet worden opgemerkt dat relatief gunstige aannames zijn gebruikt. Indien minder optimistische waarden zouden worden gebruikt, liggen de resultaten minder gunstig maar nog steeds voldoende positief. Er is echter wel sprake van veel onzekerheden. Met name de berekeningen van de lachgasemissie, N-mineralisatie en parameters voor de bodem organische stof vragen een betere onderbouwing

Incidence, Prevalence and Future Trends of Primary Basal Cell Carcinoma in the Netherlands

Abstract: Basal cell carcinoma (BCC) incidence rates are increasing worldwide. This study’s objective was to estimate the occurrence of BCC in the Netherlands in terms of incidence and prevalence. Data on first primary carcinomas were retrieved from the Eindhoven Cancer Registry and extrapolated to the Dutch population. Extrapolated data showed a total of 444,131, histologically confirmed cases in the Netherlands between 1973 and 2008. During this period, age-adjusted incidence rates (European Standard Population) increased approximately three-fold from 40 to 148 per 100,000 in males and from 34 to 141 in females. Lifetime risk of BCC was 1 in 5–6 for Dutch citizens. Disease prevalence in the Netherlands was 1.4% and almost four times higher than this (5.4%) in the oldest age group (age 65 years or more). Predictions of future trends showed no signs of a plateau in the number of cases. These estimates should urge Dutch policymakers to provide solutions for the growing group of patients with BCC

Added value of frailty and social support in predicting risk of 30-day unplanned re-admission or death for patients with heart failure: an analysis from OPERA-HF

Background: Models for predicting the outcome of patients hospitalized for heart failure (HF) rarely take a holistic view. We assessed the ability of measures of frailty and social support in addition to demographic, clinical, imaging and laboratory variables to predict short-term outcome for patients discharged after a hospitalization for HF. Methods: OPERA-HF is a prospective observational cohort, enrolling patients hospitalized for HF in a single center in Hull, UK. Variables were combined in a logistic regression model after multiple imputation of missing data to predict the composite outcome of death or readmission at 30 days. Comparisons were made to a model using clinical variables alone. The discriminative performance of each model was internally validated with bootstrap re-sampling. Results: 1094 patients were included (mean age 77 [interquartile range 68–83] years; 40% women; 56% with moderate to severe left ventricular systolic dysfunction) of whom 213 (19%) had an unplanned re-admission and 60 (5%) died within 30 days. For the composite outcome, a model containing clinical variables alone had an area under the receiver-operating characteristic curve (AUC) of 0.68 [95% CI 0.64–0.72]. Adding marital status, support from family and measures of physical frailty increased the AUC (p < 0.05) to 0.70 [95% CI 0.66–0.74]. Conclusions: Measures of physical frailty and social support improve prediction of 30-day outcome after an admission for HF but predicting near-term events remains imperfect. Further external validation and improvement of the model is required

The Arabidopsis thaliana SERK1 kinase domain spontaneously refolds to an active state in vitro

Auto-phosphorylating kinase activity of plant leucine-rich-repeat receptor-like kinases (LRR-RLK's) needs to be under tight negative control to avoid unscheduled activation. One way to achieve this would be to keep these kinase domains as intrinsically disordered protein (IDP) during synthesis and transport to its final location. Subsequent folding, which may depend on chaperone activity or presence of interaction partners, is then required for full activation of the kinase domain. Bacterially produced SERK1 kinase domain was previously shown to be an active Ser/Thr kinase. SERK1 is predicted to contain a disordered region in kinase domains X and XI. Here, we show that loss of structure of the SERK1 kinase domain during unfolding is intimately linked to loss of activity. Phosphorylation of the SERK1 kinase domain neither changes its structure nor its stability. Unfolded SERK1 kinase has no autophosphorylation activity and upon removal of denaturant about one half of the protein population spontaneously refolds to an active protein in vitro. Thus, neither chaperones nor interaction partners are required during folding of this protein to its catalytically active state

Ventricular tachycardia in ischemic cardiomyopathy; a combined endo-epicardial ablation as the first procedure versus a stepwise approach (EPILOGUE) - study protocol for a randomized controlled trial

Background: The role of epicardial substrate ablation of ventricular tachycardia (VT) as a first-line approach in patients with ischemic heart disease is not clearly defined. Epicardial ablation as a first-line option is standard for patients with nonischemic dilated cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy. Several nonrandomized studies, including studies on patients with ischemic heart disease, have shown that epicardial VT ablation improves outcome but this approach was often used after a failed endocardial approach. The aim of this study is to determine whether a combined endo-epicardial scar homogenization as a first-line approach will improve the outcome of VT ablation. Methods/Design: The EPILOGUE study is a multicenter, two-armed, nonblinded, randomized controlled trial. Patients with ischemic heart disease who are referred for VT ablation will be randomly assigned to combined endo-epicardial scar homogenization or endocardial scar homogenization only (control group). The primary outcome is recurrence of sustained VT during a 2-year follow-up. Secondary outcomes include procedural success and safety. Discussion: This study is the first randomized trial that evaluates the role of a combined endo-epicardial scar homogenization versus endocardial scar homogenization for the treatment of ischemic scar-related VT. Trial registration:NL4816807814v0

Current discharge management of acute coronary syndromes: Data from the Rijnmond Collective Cardiology Research (CCR) study

Background Medical discharge management of acute coronary syndromes (ACS) remains suboptimal outside randomised trials and constitutes an essential quality benchmark for ACS. We sought to evaluate the rates of key guideline-recommended pharmacological agents after ACS and characteristics associated with optimal treatment at discharge. Methods The Rijnmond Collective Cardiology Research (CCR) registry is an ongoing prospective, observational study in the Netherlands that aims to enrol 4000 patients with ACS. We examined discharge and 1-month follow-up medication use among the first 1000 patients enrolled in the CCR registry. Logistic regression was performed to identify patient and hospital characteristics associated with collective guidelinerecommended pharmacotherapy at hospital discharge. Results At discharge, 94%of patients received aspirin, 100% thienopyridines, 80 % angiotensin-converting enzyme inhibitors/angiotensin-II receptor blockers, 87 % β-blockers, 96 % statins, and 65 % the combination of all 5 agents. STsegment elevation myocardial infarction, hypertension, hypercholesterolaemia, and enrolment in an interventional centre were positive independent predictors of 5-drug combination therapy at discharge. Negative independent predictors were unstable angina and advanced age. Conclusion Current data from the CCR registry reflect a high quality of care for ACS discharge management in the Rotterdam-Rijnmond region. However, potential still remains for further optimisation