Effect of crisis plans on admissions and emergency visits: A randomized controlled trial

Objective: To establish whether patients with a crisis plan had fewer voluntary or involuntary admissions, or fewer outpatient emergency visits, than patients without such a plan. Design: Multicenter randomized controlled trial with two intervention conditions and one control condition. Participants: Adult outpatients diagnosed with psychotic or bipolar disorder who had experienced at least one psychiatric crisis in the previous two years. Intervention: Two types of advance statement were used: (1) a crisis plan formulated by the patient with the help of a patient advocate (Patient Advocate Crisis Plan: PACP); and (2) a crisis plan developed together with the clinician (Clinician-facilitated Crisis Plan: CCP). Outcome: The percentages of patients admitted voluntarily or involuntarily (on an emergency basis or by court order), and the percentage who made outpatient emergency visits over an 18-month follow-up period. Results: A total of 212 patients were included: 69 in the PACP condition, 70 in the CCP condition, and 73 in the control condition. No effects of the two interventions were found on the numbers of voluntary admissions, involuntary admissions and emergency visits. Regarding involuntary admissions, there was no significant effect on emergency admissions, which were 17% (12/69) in the PACP condition, 10% (7/70) in the CCP condition, and 19% (14/73) in the control condition. There was a significant effect on planned court-ordered admissions, with 16% (11/69) in the PACP condition, 10% (7/70) in the CCP condition, and 26% (19/73) in the control condition. Finally, the interventions had no effect on outpatient emergency visits, with 32% (22/69) in the PACP group, 31% (22/70) in the CCP group, and 34% (25/73) in the control group. Conclusions: Crisis plans may be an effective intervention for reducing court-ordered admissions in patients with psychotic and bipolar disorders. Trial registration: Current Controlled Trails NTR1166

VReedom: training for authorized leave of absence through virtual reality – a feasibility study

Criminal Justice: Legitimacy, accountability, and effectivit

Abiotic stress QTL in lettuce crop–wild hybrids: comparing greenhouse and field experiments

The development of stress-tolerant crops is an increasingly important goal of current crop breeding. A higher abiotic stress tolerance could increase the probability of introgression of genes from crops to wild relatives. This is particularly relevant to the discussion on the risks of new GM crops that may be engineered to increase abiotic stress resistance. We investigated abiotic stress QTL in greenhouse and field experiments in which we subjected Recombinant Inbred Lines from a cross between cultivated Lactuca sativa cv. Salinas and its wild relative L. serriola to drought, low nutrients, salt stress, and above ground competition. Aboveground biomass at the end of the rosette stage was used as a proxy for the performance of plants under a particular stress. We detected a mosaic of abiotic stress QTL over the entire genome with little overlap between QTL from different stresses. The two QTL clusters that were identified reflected general growth rather than specific stress responses and co-located with clusters found in earlier studies for leaf shape and flowering time. Genetic correlations across treatments were often higher among different stress treatments within the same experiment (greenhouse or field), than among the same type of stress applied in different experiments. Moreover, the effects of the field stress treatments were more correlated to those of the greenhouse competition treatments than to those of the other greenhouse stress experiments, suggesting that competition rather than abiotic stress is a major factor in the field. In conclusion, the introgression risk of stress tolerance (trans-)genes under field conditions cannot easily be predicted based on genomic background selection patterns from controlled QTL experiments in greenhouses. Especially field data will be needed to assess potential (negative) ecological effects of introgression of these transgenes into wild relatives

Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE Investigation.

Objectives: Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk, but the magnitude of this risk is not known precisely. A study was undertaken to investigate the associations between RA and type 2 diabetes (DM2), a well-established cardiovascular risk factor, on the one hand, and cardiovascular disease (CVD) on the other. Methods: The prevalence of CVD (coronary, cerebral and peripheral arterial disease) was determined in 353 randomly selected outpatients with RA (diagnosed between 1989 and 2001, aged 50-75 years; the CARRÉ study) and in participants of a population-based cohort study on diabetes and CVD (the Hoorn study). Patients with RA with normal fasting glucose levels from the CARRÉ study (RA, n = 294) were compared with individuals from the Hoorn study with normal glucose metabolism (non-diabetic, n = 258) and individuals with DM2 (DM2, n = 194). Results: The prevalence of CVD was 5.0% (95% CI 2.3% to 7.7%) in the non-diabetic group, 12.4% (95% CI 7.5% to 17.3%) in the DM2 group and 12.9% (95% CI 8.8% to 17.0%) in those with RA. With non-diabetic individuals as the reference category, the age- and gender-adjusted prevalence odds ratio (OR) for CVD was 2.3 (95% CI 1.1 to 4.7) for individuals with DM2 and 3.1 (95% CI 1.6 to 6.1) for those with RA. There was an attenuation of the prevalences after adjustment for conventional cardiovascular risk factors (OR 2.0 (95% CI 0.9 to 4.5) and 2.7 (95% CI 1.2 to 5.9), respectively). Conclusions: The prevalence of CVD in RA is increased to an extent that is at least comparable to that of DM2. This should have implications for primary cardiovascular prevention strategies in RA

The development of an online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making: a usability and pilot study

An online decision aid to support persons having a genetic predisposition to cancer and their partners during reproductive decision-making was developed. A two-phase usability test was conducted among 12 couples (N = 22; 2 persons participated without their partner) at risk for hereditary cancer and 15 health care providers. Couples and health care providers expressed similar suggestions for improvements, and evaluated the modified decision aid as acceptable, easy to use, and comprehensible. The final decision aid was pilot tested (N = 16) with paired sample t tests comparing main outcomes (decisional conflict, knowledge, realistic expectations regarding the reproductive options and decision self-efficacy) before (T0), immediately (T1) and 2 weeks after (T2) use of the decision aid. Pilot testing indicated decreased decisional conflict scores, increased knowledge, and improved realistic expectations regarding the reproductive options, at T1 and T2. No effect was found for couples’ decision self-efficacy. The positive findings during usability testing were thus reflected in the pilot study. The decision aid will be further evaluated in a nationwide pretest–posttest study to facilitate implementation in the onco-genetic counselling setting. Ultimately, it is expected that the decision aid will enable end-users to make an informed decision

Reproductive decision-making in the context of hereditary cancer: the effects of an online decision aid on informed decision-making

Individuals having a genetic predisposition to cancer and their partners face challenging decisions regarding their wish to have children. This study aimed to determine the effects of an online decision aid to support couples in making an informed decision regarding their reproductive options. A nationwide pretest-posttest study was conducted in the Netherlands among 131 participants between November 2016 and May 2018. Couples were eligible for participation if one partner had a pathogenic variant predisposing for an autosomal dominant hereditary cancer syndrome. Participants completed a questionnaire before use (T0), and at 3 months (T3) after use of the decision aid to assess the primary outcome measure informed decision-making, and the secondary outcome measures decisional conflict, knowledge, realistic expectations, level of deliberation, and decision self-efficacy. T0–T3 comparisons show an overall positive effect for all outcome measures (all ps < 0.05; knowledge (ES = − 1.05), decisional conflict (ES = 0.99), participants’ decision self-efficacy (ES = −0.55), level of deliberation (ES = − 0.50), and realistic expectations (ES = − 0.44). Informed decision-making increased over time and 58.0% of the participants made an informed reproductive decision at T3. The online decision aid seems to be an appropriate tool to complement standard reproductive counseling to support our target group in making an informed reproductive decision. Use of the decision aid may lessen the negative psychological impact of decision-making on couples’ daily life and wellbeing

Sanitation by ultrasonic cavitation of steel mesh gloves used in the meat industry

The microbiological condition of steel mesh gloves commonly used in the meat industry was assessed and an adequate sanitation protocol devised in the course of three experiments conducted in the boning room of a beef packaging operation. The first pilot-experiment monitored the average bacterial load of gloves at various times during the working day, by releasing the tissue trapped inside the gloves through ultrasonic cavitation. After 2, 4, and 6 h of boning, steel mesh gloves contained ca. 9.1 and 8.3 log10 CFU/g mesophilic and psychrotrophic organisms, respectively. Enterobacteriaceae colony counts varied from ca. 5.5 to 8.5 log10 CFU/g. In the second experiment ultrasonic cavitation was followed by disinfection in a 2% Halamid® (sodium paratoluene sulfonchloramide) solution for 5 min. Aerobic mesophilic and psychrotrophic colony counts after 2 h of boning were still 7.4 and 6.7 log10 CFU/g, respectively, while the average Enterobactericeae colony count was 4.9 log10 CFU/g. In the third experiment gloves were subjected to a protocol including: 1) cleaning by ultrasonic cavitation in the presence of a suitable detergent for 5 min, 2) rinsing with tap water, 3) disinfection in a 2% Halamid® solution for 5 min, and 4) rinsing with tap water. This resulted in counts below the limits of detection for aerobic organisms and Enterobacteriaceae . After 2 h of boning the average mesophilic and psychrotrophic aerobic colony counts were ca. 5.5 and 4.9 log10 CFU/g, respectively and the Enterobacteriaceae colony count ca. 3.9 log10 CFU/g. This contrasted sharply with the much higher levels observed when no sanitation protocol was followed. Hence the developed protocol reduces the risk of cross-contamination by steel mesh gloves considerably

Translations

OBJECTIVE: To compare the incidence of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) with the incidence in patients with type 2 diabetes mellitus (DM2) and that in the general population. DESIGN: Prospective, descriptive cohort study. METHOD: In 2001-2002, 353 patients with RA were included in a cohort. All patients were seen after 3 years to determine the 3-year incidence of CVD. Cox proportional hazards models were used to compare this incidence with the 3-year incidence of CVD in a general population cohort consisting of 1852 people, of which 155 had DM2. Fatal and non-fatal CVD were classified according to the ICD-9 criteria. RESULTS: The 3-year incidence of CVD was 9.0% in patients with RA and 4.3% in the general population, corresponding to an incidence of 3.30 per 100 patient-years (95% CI: 2.08-4.25) and 1.51 per 100 person-years (95% CI: 1.18-1.84) respectively. Compared with the 1852 people in the general population cohort, the age and sex-adjusted hazard ratio for CVD in RA patients was 1.94 (95% CI: 1.24-3.05; p = 0.004). This risk did not change when patients with pre-existing CVD were excluded or when the analyses were adjusted for the presence of cardiovascular risk factors. Both RA patients without DM2 and patients with DM2 had a twofold increased risk of CVD risk compared with the general population without DM2, with hazard ratios of 2.16 (95% CI: 1.28-3.63) and 2.04 (95% CI: 1.12-3.67) respectively. CONCLUSION: RA is associated with an increased risk of CVD and this risk is similar to that associated with DM2

Corrigendum: PolymapR - Linkage analysis and genetic map construction from F 1 populations of outcrossing polyploids

In the original article, there was an incorrect formula. The formula appears in section 2.2.2, 'Linkage analysis in the presence of preferential chromosomal pairing', on page 3498. The correct formula is below in the context in which it appears. This gives rise to the likelihood function (Formula Presented) , which when solved leads to the following maximumlikelihood estimate for (Formula Presented). This has been corrected</p