Improving access to and effectiveness of mental health care for personality disorders:the guideline-informed treatment for personality disorders (GIT-PD) initiative in the Netherlands

Evidence-based treatment for patients suffering from personality disorders (PDs) is only available to a limited extend in the Netherlands. Consequently, most patients receive non-manualized, unspecialized care. This manuscript describes the background, rationale and design of the Guideline-Informed Treatment for Personality Disorders (GIT-PD) initiative. GIT-PD aims to provide a simple, principle-driven, ‘common-factors’ framework for the treatment of PDs. The GIT-PD framework integrates scientific knowledge, professional expertise and patient experience to design a good-enough practice, based on common factors. It offers a basic framework including general principles, a structured clinical pathway, a basic professional stance, interventions focused on common factors, and team and organizational strategies, based on common features of evidence-based treatments and generic competences of professionals. The GIT-PD initiative has had a large impact on the organization of treatment for PDs in the Netherlands. For countries with an interest in improving their health care system for PDs, it could serve as a template that requires only limited resource

Asking for more:Teachers’ invitations for elaboration in whole-class discussions

This paper addresses the ways in which teachers in whole-class discussions invite students to elaborate their previous turn. Our conversation analytic study uncovers that the teachers’ invitations are prompted by elicited as well as spontaneous student turns of both subjective and factual nature. While giving the students the space to expand on their previous turn, most invitations nevertheless steer towards a specific type of response, namely an account or explanation. Only incidentally, the invitations simply solicit a continuation. The fact that the invitations follow not only teacher-initiated, but also student-initiated contributions reflects the teachers’ attempts to foster an actual discussion framework in which they partly hand over control and in which the student contributions are taken up for further consideration

Teachers' pass-on practices in whole-class discussions:How teachers return the floor to their students

This paper reports on a conversation analytic study into the pass-on turns that teachers produce to return the floor to the class following one student’s contribution, in the context of whole-class discussions around texts in 4th grade history and geography lessons. These pass-on turns are remarkable, as the teachers take the turn in order to convey that they will not be responding, but are instead giving their students the opportunity to do so. Our bottom-up analyses allowed us to identify different practices and their projections, and revealed their effects on the ensuing responses. Whereas minimal pass-on practices do not alter the sequential implications of the preceding student turn and typically lead to responses to the student turn, more elaborate practices do slightly alter the sequential implications and mostly lead to responses to the pass-on turn itself, or to an earlier turn produced by the teacher. The analyses show that, although the pass-on turns seem to sustain the Teacher-Student-Teacher-Student participation pattern, this does not hinder the activity of having a whole-class discussion in which students discuss the topic at hand and critically consider and challenge the contributions of their classmates

Results and long-term patient satisfaction after gluteal augmentation with platelet-rich plasma-enriched autologous fat

BACKGROUND: Buttock augmentation is gaining increasing popularity in aesthetic surgery. The relatively high incidence of complications after silicone implant placement lead to the increased use of lipofilling techniques, yielding variable results with respect to graft take rate and long-term stability. Platelet-rich plasma (PRP) has been shown to have beneficial effects on wound healing and angiogenesis in the past. Therefore, we aimed at investigating the long-term results and patient satisfaction after PRP-enriched lipofilling for buttock augmentation. METHODS: Twenty-four bilateral gluteal augmentations with PRP-enriched autologous fat were performed. Additionally, contour shaping was achieved by liposuction of the adjacent zones. Post-operative results and complications were recorded, and satisfaction with buttock shape was estimated by a patient questionnaire. RESULTS: Mean follow-up time was 44 months, and mean amount of transferred fat was 481 cc for both sides. No seroma or hematoma formation, infection or liponecrosis were reported during the post-operative follow-up. Subjective patient satisfaction in general increased from preoperatively to 3 months postoperatively and declined only slightly in the long-term course. Satisfaction levels in general were specific for each patient. Patient recovery was quick, and the majority of patients returned to work within 10 days after surgery. CONCLUSIONS: PRP-enhanced lipofilling of the buttocks proved to be a safe procedure including a low complication rate and consistent results. However, subjective patient expectations have to be taken into account when choosing the indication. Further large volume studies are needed to elucidate the potential and benefit of PRP in this context. Level of Evidence: Level IV, therapeutic study

Growth hormone producing prolactinoma in juvenile cystinosis: a simple coincidence?

Juvenile cystinosis was diagnosed in a patient who presented with severe headache attacks and photophobia. Treatment with oral cysteamine and topical cysteamine eye drops was started. One-and-a-half years later, he developed unilateral gynecomastia and elevated prolactin and growth hormone levels. A pituitary macroprolactinoma was discovered and successfully treated with the dopamine agonist cabergoline. Increased serum growth hormone levels were attributed to enhanced growth hormone production by the prolactinoma and somatostatin inhibition by cysteamine. Although the occurrence of prolactinoma in this patient could be a simple coincidence, it might also be a rare yet unrecognised complication of cystinosis

Recent Development on Underground Coal Gasification and Subsequent CO2 Storage

Underground coal gasification (UCG) is the in-situ conversion of deep underground coal to synthesis gas for heating, chemical manufacturing and power generation. UCG has been the subject of extensive pilot testing but technical and environmental concerns remain, not least its greenhouse gas emissions. An attractive solution is to combine UCG with CO2 capture and storage (CCS) so that the CO2 generated from the UCG and combustion of synthesis gas is re-injected back underground in the UCG cavities, adjacent unmineable coal seams and stressed strata. Thereby the emissions from UCG are eliminated and deep coal reserves become a new source of energy supply. This paper reviews the recent global development of UCG projects, the research progress of UCG technology and the technical developments and economic feasibility of UCG-CCS in recent EU projects

Specific Polyunsaturated Fatty Acids Can Modulate in vitro Human moDC2s and Subsequent Th2 Cytokine Release

Allergy is becoming a rapidly increasing problem worldwide, and in vitro models are frequently used to study the mechanisms behind the different types of allergic response. The dendritic cell (DC)\u2013T-cell model can be used to study sensitization. However, lipopolysaccharide (LPS) is often used to maturate the DCs, but it gives rise to a DC1 phenotype, whereas Th2-driven inflammatory diseases such as allergy are characterized by the involvement of the DC2 phenotype. Our aim was to create a DC2\u2013T-cell human model (human moDC2s) to study in vitro sensitization and validate the model using polyunsaturated fatty acids (PUFAs) that were previously shown to have immunomodulatory properties. We found that the generated DC2s expressed OX40L and drove naive T-cells into IL-13 production of CD4+ effector T-cells. In line with in vivo findings, n 123 long-chain (LC)PUFA docosahexaenoic acid (DHA) effectively decreased the DC2's surface expression of OX40L, as well as the IL-12p40 and IL-23 cytokine production by DC2s and subsequently lowered IL-13 production by DC2-induced effector T-cells. Similar cytokine production effects were found with eicosapentaenoic acid (EPA) and arachidonic acid (AA), whereas linoleic acid (LA) increased OX40L surface expression and subsequent T-cell-derived IL-13/IFN\u3b3 ratios, suggesting an increased risk of allergy development. Altogether, these data show that human moDC2s are able to induce Th2-type IL-13 secretion by T-cell differentiated in the presence of these DC2s and that this model can be differentially modulated by PUFAs. These results are in line with previous in vivo studies using PUFAs, indicating that this model may be of use to predict in vivo outcomes