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Through structured interviews and statistical analyses, this study investigated access to water and strategies of 1227 vulnerable households in Bandung, Indonesia. The use of mixed water sources, household water treatment, and home storage suggest low trust in improved sources, and compromised safety and reliability of water. While official statistics suggest a high level of access to improved water sources, full-time access to such sources is overestimated. Integration of user behavior into the new monitoring approach for the water supply sector in the post-2015 development framework is proposed. [ABSTRACT FROM AUTHOR]

All over the world, governments have established integrated river basin management projects on local and regional scales to combine functions, such as flood protection, nature restoration, and other potentially conflicting land uses (e.g. recreational and agricultural activities). This has led to collaborative arrangements between diverse administrative levels, sectors and actors in the planning and implementation phase. Following the finalization of the implementation phase, a new floodplain maintenance phase is called for. Maintaining multi-functional floodplains involves, for example, monitoring, the development of ecological infrastructure and the coordination of maintenance activities. This paper addresses how collaborative processes continue and are further shaped in the maintenance phase. Regional stakeholder's frames were examined with respect to the following components: incentives, collaborative process, allocation of tasks including related responsibilities, and outcomes. Analysis of an unsuccessful case study indicates that the collaborative processes on the organizational and action levels were insufficiently connected, because of the lack of a strategy to integrate the outcomes of both processes. Moreover, underlying conflicting perspectives on collaborative maintenance, an economic perspective versus a perspective of collaboration with a platform of local nature organizations, obstructed effective collaborative governance aimed at maintaining multi-functional floodplains. [ABSTRACT FROM AUTHOR]

IMPORTANCE Although schizophrenia is characterized by impairments in intelligence and the loss of brain volume, the relationship between changes in IQ and brain measures is not clear. OBJECTIVE To investigate the association between IQ and brain measures in patients with schizophrenia across time. DESIGN, setting, and participants Case-control longitudinal study at the Department of Psychiatry at the University Medical Center Utrecht, Utrecht, the Netherlands, comparing patients with schizophrenia and healthy control participants between September 22, 2004, and April 17, 2008. Magnetic resonance imaging of the brain and IQ scores were obtained at baseline and the 3-year follow-up. Participants included 84 patients with schizophrenia (mean illness duration, 4.35 years) and 116 age-matched healthy control participants. MAIN OUTCOMES AND MEASURES Associations between changes in IQ and the total brain, cerebral gray matter, cerebral white matter, lateral ventricular, third ventricles, cortical, and subcortical volumes; cortical thickness; and cortical surface area. RESULTS Cerebral gray matter volume (P = .006) and cortical volume (P = .03) and thickness (P = .02) decreased more in patients with schizophrenia across time compared with control participants. Patients showed additional loss in cortical volume and thickness of the right supramarginal, posterior superior temporal, left supramarginal, left postcentral, and occipital regions (P values were between <.001 and .03 after clusterwise correction). Although IQ increased similarly in patients with schizophrenia and control participants, changes in IQ were negatively correlated with changes in lateral ventricular volume (P = .05) and positively correlated with changes in cortical volume (P = .007) and thickness (P = .004) only in patients with schizophrenia. Positive correlations between changes in IQ and cortical volume and thickness were found globally and in widespread regions across frontal, temporal, and parietal cortices (P values were between <.001 and .03 after clusterwise correction). These findings were independent of symptom severity at follow-up, cannabis use, and the use of cumulative antipsychotic medications during the 3 years of follow-up. CONCLUSIONS AND RELEVANCE Progressive brain tissue loss in schizophrenia is related to relative cognitive decline during the early course of illness. [ABSTRACT FROM AUTHOR]

Although structural brain alterations in schizophrenia have been demonstrated extensively, their quantitative distribution has not been studied over the last 14 years despite advances in neuroimaging. Moreover, a volumetric meta-analysis has not been conducted in antipsychotic-naive patients. Therefore, meta-analysis on cross-sectional volumetric brain alterations in both medicated and antipsychotic-naive patients was conducted. Three hundred seventeen studies published from September 1, 1998 to January 1, 2012 comprising over 9000 patients were selected for meta-analysis, including 33 studies in antipsychotic-naive patients. In addition to effect sizes, potential modifying factors such as duration of illness, sex composition, current antipsychotic dose, and intelligence quotient matching status of participants were extracted where available. In the sample of medicated schizophrenia patients (n = 8327), intracranial and total brain volume was significantly decreased by 2.0% (effect size d = −0.17) and 2.6% (d = −0.30), respectively. Largest effect sizes were observed for gray matter structures, with effect sizes ranging from −0.22 to −0.58. In the sample of antipsychotic-naive patients (n = 771), volume reductions in caudate nucleus (d = −0.38) and thalamus (d = −0.68) were more pronounced than in medicated patients. White matter volume was decreased to a similar extent in both groups, while gray matter loss was less extensive in antipsychotic-naive patients. Gray matter reduction was associated with longer duration of illness and higher dose of antipsychotic medication at time of scanning. Therefore, brain loss in schizophrenia is related to a combination of (early) neurodevelopmental processes—reflected in intracranial volume reduction—as well as illness progression. [ABSTRACT FROM PUBLISHER]

The aim of the present study was to assess the effect of dehydroepiandrosterone (DHEA: 10 µM) and metformin (10 µM and 100 µM) in regulating proliferation of cultured T lymphocytes. T cells were isolated from lymph nodes of prepuberal BALB/c mice. We found that DHEA, metformin and DHEA + metformin added to the incubation media diminished proliferation of T cells. The inhibition by DHEA was higher than that produced by metformin, while the combined treatment showed a synergistic action that allowed us to speculate distinct regulatory pathways. This was supported later by other findings in which the addition of DHEA to the incubation media did not modify T lymphocyte viability, while treatment with metformin and DHEA + metformin diminished cellular viability and increased both early and late apoptosis. Moreover, DHEA diminished the content of the anti-oxidant molecule glutathione (GSH), whereas M and DHEA + metformin increased GSH levels and diminished lipid peroxidation. We conclude that DHEA and metformin diminish proliferation of T cells through different pathways and that not only the increase, but also the decrease of oxidative stress inhibited proliferation of T cells, i.e. a minimal status of oxidative stress, is necessary to trigger cellular response. [ABSTRACT FROM AUTHOR]

OBJECTIVES: A globally acceptable definition and classification of gastroesophageal reflux disease (GERD) is desirable for research and clinical practice. The aim of this initiative was to develop a consensus definition and classification that would be useful for patients, physicians, and regulatory agencies. METHODS: A modified Delphi process was employed to reach consensus using repeated iterative voting. A series of statements was developed by a working group of five experts after a systematic review of the literature in three databases (Embase, Cochrane trials register, Medline). Over a period of 2 yr, the statements were developed, modified, and approved through four rounds of voting. The voting group consisted of 44 experts from 18 countries. The final vote was conducted on a 6-point scale and consensus was defined a priori as agreement by two-thirds of the participants. RESULTS: The level of agreement strengthened throughout the process with two-thirds of the participants agreeing with 86%, 88%, 94%, and 100% of statements at each vote, respectively. At the final vote, 94% of the final 51 statements were approved by 90% of the Consensus Group, and 90% of statements were accepted with strong agreement or minor reservation. GERD was defined as a condition that develops when the reflux of stomach contents causes troublesome symptoms and/or complications. The disease was subclassified into esophageal and extraesophageal syndromes. Novel aspects of the new definition include a patient-centered approach that is independent of endoscopic findings, subclassification of the disease into discrete syndromes, and the recognition of laryngitis, cough, asthma, and dental erosions as possible GERD syndromes. It also proposes a new definition for suspected and proven Barrett's esophagus. CONCLUSIONS: Evidence-based global consensus definitions are possible despite differences in terminology and language, prevalence, and manifestations of the disease in different countries. A global consensus definition for GERD may simplify disease management, allow collaborative research, and make studies more generalizable, assisting patients, physicians, and regulatory agencies. [ABSTRACT FROM AUTHOR]

Studies the sequence of interleukin 1beta actions on corpus luteum regression. Relationship with inducible cyclooxygenase and nitric oxide synthase expression; Reversible decline in serum progesterone concentration.

Objectives: To investigate whether a low peripheral blood lymphocyte count is associated with increased mortality risk in older persons and to determine whether this association could be ascribed to ill health. Design: A cohort study with a total follow-up period of 1,602 person years. Setting: Leiden, the Netherlands. Participants: Four hundred thirty-six community-dwelling residents aged 85 and older. Measurements: Health status and leukocyte total and differential counts were assessed at baseline. Lymphocyte subsets were measured with a fluorescence-activated cell sorter. Age- and sex-adjusted mortality risks were estimated using Cox proportional hazard regression analysis. Results: There was no association between lymphocyte count and mortality in persons with ill health (mortality risk lowest vs highest quartile=1.16; 95% confidence interval (CI)=0.85–1.58, P =.35), but mortality was dependent on lymphocyte count if disease was excluded (mortality risk lowest vs highest quartile=2.14; 95% CI=1.08–4.23, P =.03). A similar increase in mortality risk was found when the cluster designation (CD)4[sup +] , CD8[sup +] , and CD16[sup +] lymphocyte subsets were analyzed. Within individuals, low values of the lymphocyte subsets were related and there was no compensatory increase in CD16[sup +] lymphocyte counts. A low lymphocyte count was not associated with specific causes of death. Conclusion: A low lymphocyte count was associated with an increased mortality risk in older persons without apparent disease. This association was not only found for the total lymphocyte count but also for the CD4[sup +] , CD8[sup +] , and CD16[sup +] lymphocyte subset counts. [ABSTRACT FROM AUTHOR]