The Amsterdam Studies of Acute Psychiatry - II (ASAP-II): a comparative study of psychiatric intensive care units in the Netherlands

Background The number of patients in whom mental illness progresses to stages in which acute, and often forced treatment is warranted, is on the increase across Europe. As a consequence, more patients are involuntarily admitted to Psychiatric Intensive Care Units (PICU). From several studies and reports it has become evident that important dissimilarities exist between PICU's. The current study seeks to describe organisational as well as clinical and patient related factors across ten PICU's in and outside the Amsterdam region, adjusted for or stratified by level of urbanization. Method/Design This paper describes the design of the Amsterdam Studies of Acute Psychiatry II (ASAP-II). This study is a prospective observational cohort study comparing PICU's in and outside the Amsterdam region on various patient characteristics, treatment aspects and recovery related variables. Dissimilarities were measured by means of collecting standardized forms which were filled out in the framework of care as usual, by means of questionnaires filled out by mental health care professionals and by means of extracting data from patient files for every consecutive patient admitted at participating PICU's during a specific time period. Urbanization levels for every PICU were calculated conform procedures as proposed by the Dutch Central Bureau for Statistics (CBS). Discussion The current study may provide a deeper understanding of the differences between psychiatric intensive care units that can be used to promote best practice and benchmarking procedures, and thus improve the standard of care

Agriculture in the third National Environmental Outlook ; assumptions and results

Dit rapport bevat de achtergronden van het onderdeel landbouw in de Derde Nationale Milieuverkenning 1993-2015. Het basisjaar voor de scenarios is 1990. Op basis van het begin 1993 vastgestelde en voorgenomen milieubeleid wordt een vooruitblik gepresenteerd voor de jaren 1995, 2000 en 2010. De evaluatie richt zich hoofdzakelijk op fosfaat, stikstof en zware metalen. Deel I geeft de uitgangspunten van de modelberekeningen. Deel II bevat de resultaten van de modelberekeningen. Tevens worden de resultaten geanalyseerd en vergeleken met andere scenario-studies zoals de evaluatie van het mest- en ammoniakbeleid door TNO en Heidemij Advies en berekeningen in het kader van de Notitie Derde Fase mest- en ammoniakbeleid.This report describes the implementation of the environmental policy with regard to nutrients (as developed until 1993) in the agricultural sector of the Dutch economy and its effects on eutrophication, ammonia-emissions and heavy metals supply to soils. Part one describes the assumptions made on key variables, necessary to calculate the amount of manure produced and its accompanying emissions. Each of these variables requires quantification of its development over time, up until 2010. Such variables include: livestock numbers, composition of excreta, penetration of techniques that reduce ammonia-volatilization. Part two gives an overview of (intermediate and final) results of the calculations and presents data on manure production and distribution, ammonia emissions from manure, application rates of N and P (both from manure and chemical fertilizer) on crop-soil-combinations. It also contains material balances for nitrogen and phosphorus for the Dutch agricultural system in the years 1986, 1990, 1995, 2000 and 2010.DGM-S

Influence of income and price changes on car ownership and use, energy, and emissions

NB! Bij dit rapport hoort een bijlage onder hetzelfde nummer (306 p.) De pdf bevat rapport en bijlage (vanaf pagina 227).Volgens het personenautomodel FACTS kennen prijsmaatregelen een verschillende invloed op het autobezit en gebruik, afhankelijk van de wijze waarop de maatregelen ingevoerd worden (procentueel of een vast bedrag, algemene maatregel of gedifferentieerd naar auto-/brandstoftype) en de kostenpost waarop de prijsmaatregel van toepassing is (MRB, BPM, brandstof, rekeningrijden e.d.). Daarnaast blijkt de invloed afhankelijk te zijn van de scenariocontext en de omvang van de prijsmaatregel. Tenslotte is het effect van de maatregel in de tijd niet constant. Indien twee prijsmaatregelen worden gecombineerd blijkt het effect in 30% van de gevallen af te wijken van het 'verwachte' effect (het gecombineerde effect bij 'onafhankelijkheid' van de maatregelen). Soms treedt zelfs onderlinge tegenwerking op. Emissies van NOx en VOS zijn naast veranderingen in de omvang van het autogebruik sterk afhankelijk van eventuele wijzigingen in de aandelen diesel, benzine en LPG. Vanwege de soms niet verwachte resultaten bij gecombineerde maatregelen en vanwege de gevoeligheid van de NOx- en VOS-emissies voor veranderingen in de aandelen benzine, diesel en LPG, verdient het aanbeveling beleidsvragen te beantwoorden met behulp van modelsimulaties in plaats van gebruik te maken van bekende simulaties en/of literatuur.The FACTS car computer model is used for predicting the influence of income and price changes on car ownership and use, and energy and emissions. The great number of simulations show that the macro-economic scenario is seen to influence the effect of income and price measures. The influence of pricing measures on car ownership and use depend on how price increases are introduced, e.g. an absolute or percentage-wise price increase, a general increase for all car models or an increase that varies with the car model (fuel, weight). Further, the influence of pricing measures depends on the cost item increased (e.g. fuel and other variable prices, sales taxes on new cars and annual road taxes). Finally, the effect of a measure changes over time. If two measures are combined, the overall effect is in 30% of the cases seen to differ from the 'expected' effect (if measures are independent). Sometimes combined price measures can even counteract each other, causing less effect than only one pricing measure. Emissions of VOC and NOx depend on the number of kilometres driven and changes in the share of the total diesel, petrol and LPG. For these two reasons it is recommended to simulate effects of combined measures and effects on VOC and NOx emissions rather than to use existing model output and/or literature studies on effects.DG