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Contains fulltext : 291117.pdf (Publisher’s version ) (Open Access) Apathy is common after stroke and has been associated with cognitive impairment. However, causality between post-stroke apathy and cognitive impairment remains unclear. We assessed the course of apathy in relation to changes in cognitive functioning in stroke survivors. Using the Apathy Scale (AS) and cognitive tests on memory, processing speed and executive functioning at six- and 15 months post-stroke we tested for associations between (1) AS-scores and (change in) cognitive scores; (2) apathy course (persistent/incident/resolved) and cognitive change scores. Of 117 included participants, 29% had persistent apathy, 13% apathy resolving over time and 10% apathy emerging between 6-15 months post-stroke. Higher AS-scores were cross-sectionally and longitudinally associated with lower cognitive scores. Relations between apathy and cognitive change scores were ambiguous. These inconsistent relations between apathy and changes in cognition over time suggest that post-stroke apathy does not directly impact cognitive performance. Both these sequelae of stroke require separate attention. 01 januari 2023 12 p.

Pressurized thermal shock (PTS) in a reactor pressure vessel could lead to a sudden brittle and catastrophic cleavage fracture. The combination of radiation embrittlement, the thermal stresses, and low temperatures can cause severe conditions for the structures. Particularly thick-walled reactor pressure vessels, which contain weak spots such as welds and cracks. In order to assess the probability for the initiation and propagation of a cleavage crack, a detailed image of the stress intensity and the temperature is needed. The critical stress intensity for brittle cleavage fracture depends on the ductile to brittle transition temperature. This complex combination of stresses, absolute temperatures and temperature gradients in combination with radiation damage requires an integral approach for the evaluation of the probability for the occurrence of cleavage fracture. In order to get the most accurate image as possible of this problem, in previous work by the authors, simulations were performed with a combined CFD and FEM approach. Where a CFD model simulates the thermal mixing of the fluid and its effects on the reactor pressure vessel wall. The temperature profile on the reactor pressure wall is then used as input of a static structural model using FEM. Over the last few years the complexity of the models increased and different types of transients were investigated [1, 2]. Reducing the amount of modelling simplifications and assumptions should lead to the most complete picture of the risks of the accident scenario. However in order to increase the speed of the calculations some simplifications are needed. In the coming years the simplifications will be added stepwise and their results will be checked against more complicated models. With a focus on verifying the stress intensity around a pre-existing crack, which leads directly to an increase on the probability of cleavage. In order to correctly predict thermal mixing in the fluid, a computationally expensive 3D model is needed. However the full temperature distribution in the reactor pressure vessel at all times is not necessarily needed to determine the stress intensity. A finite element analysis has been performed on a small section of the reactor pressure vessel [3], speeding up the simulations significantly. The largest amount of simulation time is spend on modelling the fluid using CFD. Other approaches to do this involve Thermal Hydraulic models, such as applied in the FAVOR code. The drawback of those codes is that they do not provide fluctuations which we can observe using CFD. A first approach of a comprehensive model which features the heat transition during a transient and the resulting stress intensity. A comparison with the computationally more expensive methods is made. A significant calculation time reduction can be achieved, but more work is needed in order to perform sufficient simulations to account for a full probabilistic analysis.

This paper presents the probabilistic study for Leak Before Break (LBB) assessments. The research has been carried out with an in-house developed software that allows to perform both probabilistic and deterministic leak before break analyses for pressurized pipes. The study is based on the UK procedure for the assessment of the integrity of structures containing defects (R6). The procedure applied is the Detectable Leak Before Break (DLBB) that relies on the Failure Assessment Diagram (FAD) Option 1 assessment procedure. The calculations merge the plastic collapse assessment and the brittle failure mode of the pipe in the FAD. The first computed parameter for the LBB assessment is the Critical Crack Length (CCL) distribution density of the postulated through wall defect. The structural integrity assessment is then coupled with the Henry-Fauske two-phase critical flow model for the evaluation of the Leakage Rate (LR). With this coupling the Minimum Detectable Crack Length (MDCL) distribution density is calculated. This step sets the boundary conditions for the fracture mechanics assessment of the postulated defect. The main probabilistic outputs from the assessment are the probability of the structural failure and the probability that the defect does not leak a detectable amount of coolant. The probabilistic method used is the Latin Hypercube Sampling; the Monte Carlo method is applied for verification. These results are then compared with the deterministic output from the LBB procedure.

For many nuclear power plants worldwide the operation period will be extended to 60 or 80 years. As the operation period increases, the importance of knowledge of ageing mechanisms increases. In the framework of LTO there is limited knowledge about ageing and structural integrity of concrete structures. Recent developments have shown that ageing of civil structures receive more attention internationally. In order to increase the knowledge in the field of civil structures, this paper focusses on investigation of ageing of civil structures and determining an ageing management strategy. Knowledge of the ageing mechanisms of civil structures and especially concrete, will lead to improvement of ageing management and assessment methods of concrete. The presented work is part of ongoing research. In the past several steps have been made. Gathering of international information on civil structures ageing issues and management thereof (see PVP2019-93029 [3]), testing of a proposed assessment methodology by application to a nuclear reactor and comparison with another PWR with a steel containment (see PVP2020-21838 [4]) and creating a list of plant specific AMPs dealing with the relevant mechanisms at the various locations in a practical manner (see PVP2021-61499 [5]). The result was a general list with possible relevant locations and what type of measures could be taken. The current steps in the research focus on material behavior of structural concrete and practical assessment in finite element modelling techniques. In a this step, the concrete material and behavior will be investigated and explained. The characteristic properties of the concrete will be summarized and the degradation mechanisms will be identified. The assessment criteria for concrete finite element modelling are defined. The overall goal of the project is to obtain more knowledge on ageing management of civil structures and especially concrete. In the current research steps the aim is to create a predictive tool with the FE modelling technique for the damage quantification in concrete due to its ageing mechanism. The results of this ongoing work are presented in this report. The characteristic properties, degradation mechanisms including modelling options are identified together with an investigation on the assessment criteria for concrete finite element modelling. The behavior of structural concrete will be explained. The conclusion represents input parameters, modelling options and assessment criteria for finite element modelling of concrete. In the future steps a practical assessment in finite modelling techniques will be introduced in order to take into consideration the degradation of the concrete. The material properties will be analyzed and adapted in an FE Model.

E-type open-source software inevitably grows in size and complexity over time, and without performing anti-regressive tasks this type of software has a limited lifespan. In this project, a case study of the effect of such anti-regressive tasks is conducted using GrimoireLab Graal as a subject. This process is guided by quality metrics and developer insights. The outcome of this work is a life-cycle of maintenance activities, ultimately resulting in a refactored version of GrimoireLab Graal. After applying anti-regressive actions, commonly used software quality metrics decreased (lower is better). Additionally, after performing an experiment to test the evolution readiness of the software, the complexity of the original software increased significantly, whilst no side effects were measured in the revised software.

Background Acute kidney injury (AKI) is a frequent complication after liver transplantation. Although numerous risk factors for AKI have been identified, their cumulative impact remains unclear. Our aim was therefore to design a new model to predict post-transplant AKI. Methods Risk analysis was performed in patients undergoing liver transplantation in two centres (n = 1230). A model to predict severe AKI was calculated, based on weight of donor and recipient risk factors in a multivariable regression analysis according to the Framingham risk-scheme. Results Overall, 34% developed severe AKI, including 18% requiring postoperative renal replacement therapy (RRT). Five factors were identified as strongest predictors: donor and recipient BMI, DCD grafts, FFP requirements, and recipient warm ischemia time, leading to a range of 0–25 score points with an AUC of 0.70. Three risk classes were identified: low, intermediate and high-risk. Severe AKI was less frequently observed if recipients with an intermediate or high-risk were treated with a renal-sparing immunosuppression regimen (29 vs. 45%; p = 0.007). Conclusion The AKI Prediction Score is a new instrument to identify recipients at risk for severe post-transplant AKI. This score is readily available at end of the transplant procedure, as a tool to timely decide on the use of kidney-sparing immunosuppression and early RRT.

Background & Aims: Liver transplantation (LT) has been proposed as an effective salvage therapy even for the sickest patients with acute-on-chronic liver failure (ACLF). This large collaborative study was designed to assess the current clinical practice and outcomes of patients with ACLF who are wait-listed for LT in Europe. Methods: This was a retrospective study including 308 consecutive patients with ACLF, listed in 20 centres across 8 European countries, from January 2018 to June 2019. Results: A total of 2,677 patients received a LT: 1,216 (45.4%) for decompensated cirrhosis. Of these, 234 (19.2%) had ACLF at LT: 58 (4.8%) had ACLF-1, 78 (6.4%) had ACLF-2, and 98 (8.1%) had ACLF-3. Wide variations were observed amongst countries: France and Germany had high rates of ACLF-2/3 (27-41%); Italy, Switzerland, Poland and the Netherlands had medium rates (9-15%); and the United Kingdom and Spain had low rates (3-5%) (p 4 mmol/L (hazard ratio [HR] 3.14; 95% CI 1.37-7.19), recent infection from multidrug resistant organisms (HR 3.67; 95% CI 1.63-8.28), and renal replacement therapy (HR 2.74; 95% CI 1.37-5.51) were independent predictors of post-LT mortality. During the same period, 74 patients with ACLF died on the waiting list. In an intention-to-treat analysis, 1-year survival of patients with ACLF on the LT waiting list was 73% for ACLF-1 or-2 and 50% for ACLF-3. Conclusion: The results reveal wide variations in the listing of patients with ACLF in Europe despite favourable post-LT survival. Risk factors for mortality were identified, enabling a more pre-cise prognostic assessment of patients with ACLF. Lay summary: Acute-on-chronic liver failure (ACLF) is a severe clinical condition for which liver transplantation is an effective therapeutic option. This study has demonstrated that in Europe, referral and access to liver transplantation (LT) for patients with ACLF needs to be harmonised to avoid inequities. Post-LT survival for patients with ACLF was >80% after 1 year and some factors have been identified to help select patients with favourable outcomes. (C) 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All reserved.

For many nuclear power plants worldwide the operation period will be extended to 60 or 80 years in the coming years. As the operation period increases, the importance of knowledge of ageing mechanisms increases. In the framework of LTO there is limited knowledge about ageing and structural integrity of concrete structures. Recent developments have shown that ageing of civil structures receive more attention internationally. In order to increase the knowledge in the field of civil structures, this paper focusses on investigation of ageing of civil structures and determining an ageing management strategy. Knowledge of the ageing mechanisms of civil structures and especially concrete, will lead to improvement of ageing management and assessment methods of concrete. As a first step international information was gathered on civil structures ageing issues and management thereof (see PVP2019-93029). In addition a highlevel assessment methodology was proposed. In the next step the initially proposed assessment methodology has been tested by application to a nuclear reactor. The resulting list of relevant AMPs has been verified with the outcome for another PWR with a steel containment. With this experience the assessment methodology is tested, compared and improved (see PVP2020-21838). The results indicated that the method can be used to obtain a list of plant specific AMPs. What was added to the assessment method is the link to the TLAAs for civil structures. In this follow up step the transition is made from a high level of IGALL AMPs to a practical AMPs that will deal with the right mechanism at the right location. The detailing to a level of practical work instructions for the maintenance of the plant has to be made in order to make real life implementation possible. In this step studying of relevant degradation mechanisms, relevant AMPs (like IAEA AMP305 and AMP306 ) and applicable literature in combination with the practical knowledge from operation of a reactor, has taken place. The international developments on ageing management of concrete will be included. The goal of the project is to obtain more knowledge on ageing management of civil structures and especially concrete. It will lead to an assessment method for civil ageing management and ageing management programs dealing with the relevant mechanisms at the various locations in a practical manner. The results of this ongoing work are presented in this report. For the research reactor all SSCs in scope of the Continued Safe Operation could be linked to the relevant AMP(s) and a resulting set of plant specific AMPs for civil ageing management was obtained. Including the international developments, literature and guidelines, a more general applicable list was created (Table 5 through Table 13). The conclusion is that Figure 2 represents a practical method for obtaining a set of plant specific civil AMPs ready for implementation. For representation in this paper the final outcome is given in as a generic list of actions for a generic reactor (Table 5 through Table 13). In these tables the relevant SSCs, ageing mechanisms and actions are listed. The tables represent an generic list of actions for civil ageing management that might others help develop their ageing management program. Future steps are shifting the focus from the general but practical assessment methodology to finite element modelling techniques for concrete. The assessment criteria for concrete (e.g. in ASME III, ASME XIII or Eurocode) will be investigated and investigation on the modelling of the concrete for ageing are planned.

In 2020, the CFD analyses have been performed on a whole reactor vessel model. The action of accumulators during the PTS transient was considered. Using these data, an attempt to the efficient use of sub-modelling is carried out in order to obtain a strong reduction in the computational costs compared to a full 3D analysis. The analyses were given a probabilistic view by using the Master Curve approach for determining the material(s) fracture toughness. In parallel with these activities, a literature review work was carried out at NRG. The single temperature dependence of the Master Curve was incorporated into characterizations of fracture toughness for all RPV steels of interest such as SA 508 Grade 3 and Grade 4N for both forging and weld material. The literature review helps to prove that the Master Curve approach models the temperature dependence of fracture toughness for a generic pressure vessel before and after irradiation. This is because all of these steels have a BCC matrix phase lattice structure. Based on ASTM E1921, the types of microstructure falling under a BBC matrix, such as bainite, tempered bainite, tempered martensite, ferrite and pearlite, could also be evaluated using the Master Curve model. Furthermore, it is found that the chemical composition is one of parameter to look for as driving force in embrittlement RPV due to irradiation. For the very high nickel steels examined (SA508 Grade 4N), when not combined with copper and moderate manganese, irradiation is not a serious embrittling agent. This paper describes the work performed at NRG in the years 2017–2020 in investigting the Pressurized Thermal Shock (PTS) phenomenon, summarizes the achievements and gives a general judgement of the lessons learned. Moreover, this paper aims to illustrate the scope of planned research on PTS and its role in the new NRG research program PIONIER 2021–2024. An overview of NRG’s effort to align itself with the international community is given. Particular attention is given to the probabilistic problematic related to PTS. In order to better understand this problematic and improve the current state of knowledge NRG will create a PFM tool. The tool aims to use the best practices from existing PFM software to try to answer to questions requiring attention (e.g. thermal-hydraulic uncertainty). The experience accumulated during the previous activities will be included in the tool.

Somatisch Onvoldoende verklaarde Lichamelijke Klachten (SOLK) komen veel voor bij jongeren, maar tot dusver is daar weinig onderzoek naar gedaan. Als er meer bekend is over de oorzaak kan er meer inzicht ontstaan in de werkzame factoren van de behandeling van SOLK binnen de geestelijke gezondheidszorg (ggz). In deze pilotstudie wordt onderzocht of experientiele vermijding en passieve coping bij pijn samenhangen met SOLK. Eenentwintig jongeren gediagnosticeerd met een somatisch-symptoomstoornis bij het Centrum voor Lichamelijk Onverklaarde Klachten (CLOK) van De Bascule (een academische instelling voor kind- en jeugdpsychiatrie) werden middels de Pain Response Inventory (PRI) en de Acceptance and Action Questionnaire-II‑7 (AAQ-II-7) vergeleken met 29 jongeren zonder SOLK geworven op drie scholen in Noord-Holland. De jongeren in de SOLK-groep blijken meer passieve coping en experientiele vermijding te gebruiken dan de jongeren in de controlegroep. Implicaties voor de klinische praktijk worden besproken om te komen tot een specifiekere behandeling voor jongeren met SOLK.

Blindsight refers to the observation of residual visual abilities in the hemianopic field of patients without a functional V1. Given the within- and between-subject variability in the preserved abilities and the phenomenal experience of blindsight patients, the fine-grained description of the phenomenon is still debated. Here we tested a patient with established "perceptual" and "attentional" blindsight (c.f. Danckert and Rossetti, 2005). Using a pointing paradigm patient MS, who suffers from a complete left homonymous hemianopia, showed clear above chance manual localisation of 'unseen' targets. In addition, target presentations in his blind field led MS, on occasion, to spontaneous responses towards his sighted field. Structural and functional magnetic resonance imaging was conducted to evaluate the magnitude of V1 damage. Results revealed the presence of a calcarine sulcus in both hemispheres, yet his right V1 is reduced, structurally disconnected and shows no fMRI response to visual stimuli. Thus, visual stimulation of his blind field can lead to "action blindsight" and spontaneous antipointing, in absence of a functional right V1. With respect to the antipointing, we suggest that MS may have registered the stimulation and subsequently presumes it must have been in his intact half field.

Reframing cognitions is assumed to play an important role in treatment for obsessive–compulsive disorder (OCD). However, there hardly is any empirical support for this assumption, especially for children. The aim of this study was to examine if changing dysfunctional beliefs is a mediating mechanism of cognitive behavioral therapy (CBT) for childhood OCD. Fifty-eight children (8–18 years) with OCD received CBT. Dysfunctional beliefs (OBQ-CV) and OCD severity (CY-BOCS) were measured pre-treatment, mid-treatment, post-treatment, and at 16-week follow-up. Results showed that OCD severity and dysfunctional beliefs decreased during CBT. Changes in severity predicted changes in beliefs within the same time interval. Our results did not support the hypothesis that changing dysfunctional beliefs mediates treatment effect. Future studies are needed to replicate these findings and shed more light on the role of explicit and implicit cognitions in treatment for childhood OCD.

For many nuclear power plants worldwide the operation period will be extended to 60 or 80 years in the coming years. As the operation period increases, the importance of knowledge of ageing mechanisms increases. In the framework of LTO there is limited knowledge about ageing and structural integrity of concrete structures. Recent developments have shown that ageing of civil structures receive more attention internationally (for example concrete degradation in bunker building Doel and buried piping attention in topical peer review EU). In order to increase the knowledge in the field of civil structures, this work focusses on investigation of ageing of civil structures and determining an ageing management strategy. Knowledge of the ageing mechanisms of civil structures and especially concrete, will lead to improvement of ageing management and assessment methods of concrete. As a first step international information was gathered on civil structures ageing issues and management thereof (see PVP2019-93029). In addition a very high level assessment methodology was proposed. The goal of the project is to obtain more knowledge on ageing management of civil structures and especially concrete. It will lead to an assessment method for civil ageing management and ageing management programs dealing with the relevant mechanisms at the various locations in a practical manner. The results of this ongoing work are presented in this report. The initial proposed assessment methodology has been tested by application to the HFR research reactor. The resulting list of relevant AMPs has been verified with the outcome for another PWR with a steel containment. With this experience the assessment methodology is improved. In addition each civil SSC in the scope of the Continued Safe Operation program is linked to the relevant AMP(s). The improved, but not finalized assessment method of ageing management for civil structures can be seen in figure 2. The proposed assessment method for ageing of civil structures has been tested, compared and improved. The results indicated that the method can be used to obtain a list of plant specific AMPs. The comparison of the list of relevant AMPs for a steel containment PWR, showed similar results. What is added to the assessment method is the link to the TLAAs for civil structures. The detailing to a level of practical work instructions for the maintenance of the plant has to be made in the near future. In the near future the step will be made from a high level of IGALL AMP to a practical AMP that will deal with the relevant mechanisms at the various locations. Therefore further steps are in studying of relevant degradation mechanisms, relevant AMPs (like AMP305 [9],AMP306 [10]) and applicable literature (e.g.[21]) in combination with the practical knowledge from operation of a reactor. The international developments on ageing management of concrete will be included. It is foreseen that the future report will contain information on concrete degradation mechanisms relevant for nuclear reactors. If findings requires calculations the assessment method will be verified with the finite element modelling techniques.

Fatigue is an important ageing mechanism for long-term operation (LTO) of nuclear power plants. The effect of the reactor coolant environment on fatigue is one of the factors to take into account. Application of environmental fatigue codes, generally, leads to large margins for actual fatigue failure of components. In combination with longer operation times, these margins can make it challenging to meet the criteria defined in the standards. The purpose of the work in this paper is, therefore, to gain insight into the conservatism in typical fatigue analyses using design fatigue curves which is done by analyzing the fatigue process up to the actual component failure using crack growth analyses. Prediction of fatigue failure in cylindrical specimen is investigated through numerical simulations of fracture mechanics. A finite element analysis model is implemented for a crack in a cylindrical specimen typically used for fatigue life testing and generating design fatigue curves. The specimen is uniaxially displacement-loaded into the plastic regime, and the reaction force is evaluated as a function of crack depth and shape. Cyclic loading leads to formation of a crack with the depth such that a failure point in the S-N curve corresponds to the 25% load drop. Stress intensity factors are calculated, and number of cycles to failure are determined based on Paris’ law and a two-stage crack growth relationship. Simulation results are compared to experimental fatigue life data and show good agreement. The outcome of the investigation can be extended to fatigue life of geometrically complex thermo-mechanical components, such as nozzles, under transient thermal loading occurring during operation of a nuclear power plant, in order to assess conservatism of fatigue failure criteria based on experimentally obtained S-N design curves.

The High Flux Reactor (HFR) is a multipurpose nuclear reactor located in Petten, the Netherlands. With its 45 MWth it is one of the most powerful and versatile research reactors in the world. Its main roles are material irradiation and medical isotopes production. The output of the reactor in terms of medical isotopes is important at a global level (60% of European demand). Every day in the Netherlands alone 30.000 patients are treated using isotopes produced in the HFR. The importance of the HFR dates back in time. The HFR has been in service since 1961. Due to the long life (58 years to date) of the reactor an efficient integrated ageing management program (AMP) is envisaged as it is foreseen that the HFR will continue to operate for a prolonged period of time. The development of the AMP has begun in 2018 (CSO project) and will be completed in view of the IAEA CSO mission. The HFR is the second reactor in the world to undergo this type of IAEA review and one of the objectives of this project is to set a state of the art when it comes to research reactors long term operation. The CSO project foresees four major sections: scoping and screening, development and improvement of plant programs, (re) validation of time limited ageing analyses (TLAAs) and realization of the ageing management program. In this paper the focus will lie on the TLAAs. The applicable TLAAs were scoped starting from the IGALLs TLAAs list. The TLAAs relevant for the HFR are: TLAA fatigue, TLAA reactor vessel, TLAA leak before break, TLAA manufacturing flaws TLAA beryllium and TLAA equipment qualification. The latter was developed in the framework of the equipment qualification plant program and does not figure as an independent TLAA in the CSO project. For each TLAA the principal problematics will be highlighted and the possible solutions illustrated.

BackgroundThe Dutch-Flemish PROMIS® Upper Extremity (DF-PROMIS-UE) V2.0 item bank was recently developed using Item Response Theory (IRT). Unknown for this bank are: (1) if it is legitimate to calculate IRT-based scores for short forms and Computerized Adaptive Tests (CATs), which requires that the items meet the assumptions of and fit the IRT-model (Graded Response Model [GRM]);(2) if it is legitimate to compare (sub) groups of patients using this measure, which requires measurement invariance; and (3) the precision of the estimated patients’ scores for patients with different levels of functioning and compared to legacy measures. Aims were to evaluate (1) the assumptions of and fit to the GRM, (2) measurement invariance and (3) (comparative) precision of the DF-PROMIS-UE v2.0.MethodsCross-sectional data were collected in Dutch patients with upper extremity disorders. Assessed were IRT-assumptions (unidimensionality [bi-factor analysis], local independence [residual correlations], monotonicity [coefficient H]), GRM item fit, measurement invariance (absence of Differential Item Functioning [DIF] due to age, gender, center, duration, and location of complaints) and precision (standard error of IRT-based scores across levels of functioning). To study measurement invariance for language [Dutch vs. English], additional US data were used. Legacy instruments were the Disability of the Arm, Shoulder and Hand (DASH), the QuickDASH and the Michigan Hand Questionnaire (MHQ).ResultsIn total 521 Dutch (mean age ± SD = 51 ± 17 years, 49% female) and 246 US patients (mean age ± SD = 48 ± 14 years, 69% female) participated. The DF-PROMIS-UE v2.0 item bank was sufficiently unidimensional (Omega-H = 0.80, Explained Common Variance = 0.68), had negligible local dependence (four out of 1035 correlations > 0.20), good monotonicity (H = 0.63), good GRM fit (no misfitting items) and demonstrated sufficient measurement invariance. Precise estimates (Standard Error The DASH displayed better reliability than the DF-PROMIS-UE short form and standard CAT, the QuickDASH displayed comparable reliability. The MHQ-ADL displayed better reliability than the DF-PROMIS-UE short form and standard CAT for T-scores between 28 and 50. For patients with low function, the DF-PROMIS-UE measures performed better.ConclusionsThe DF-PROMIS-UE v2.0 item bank showed sufficient psychometric properties in Dutch patients with UE disorders.

Evidencebased behandelen en het monitoren van behandelresultaten met behulp van objectieve meetinstrumenten zijn belangrijke speerpunten in de jeugd-ggz. Echter, deze werkwijze is nog niet standaard. Implementatie van evidencebased behandelen heeft een positief effect op het behandelresultaat, blijkt uit onderzoek bij volwassenen. In de jeugd-ggz is dit echter nog nauwelijks onderzocht. In dit onderzoek hebben we het resultaat gemeten van een implementatietraject van evidencebased behandelen bij een instelling voor jeugd-ggz. Het implementatietraject bestond uit een intensief scholingsprogramma met als doel a) toename van monitoren van de behandeling door behandelaren, b) verkorting van de behandelduur, en c) verbetering van het behandelresultaat. Er werd een pre-post-design toegepast, waarbij twee client-cohorten vergeleken werden: een baseline-cohort, behandeld voorafgaand aan het scholingsprogramma, en een implementatie-cohort, behandeld een half jaar tot een jaar na de start ervan. Voor het bepalen van het behandelresultaat gebruikten we de Strengths and Difficulties Questionnaire (SDQ) voor clienten jonger dan zeventien jaar en de Outcome Questionnaire 45 (OQ45) voor clienten van zeventien jaar en ouder. De behandelduur werd bepaald in weken, vanaf de eerste behandelsessie tot afsluiting van de behandeling. Het monitoren van behandelingen nam na het scholingsprogramma significant toe (van 47% naar 72%), evenals het behandelresultaat (van een gemiddelde delta T van 3,3 naar een gemiddelde delta T van 6,5). De behandelduur bleef hetzelfde. Ruim een derde van de behandelingen duurde langer dan een jaar. Een implementatietraject middels een intensief scholingsprogramma heeft mogelijk een bijdrage geleverd aan het verbeteren van het behandelresultaat bij een instelling voor jeugd-ggz. Onderzoek naar behandelingen die langer dan een jaar duren is van belang.

The aim of this study was to investigate the impact of hypoxia and hypotension during the agonal phase of donor warm ischemia time (DWIT) on hepatic ischemia/reperfusion injury (IRI) and complications in donation after circulatory death (DCD) liver transplantation. A retrospective single‐center study of 93 DCD liver transplants (Maastricht type III) was performed. DWIT was divided into 2 periods: the agonal phase (from withdrawal of treatment [WoT] until circulatory arrest) and the asystolic phase (circulatory arrest until cold perfusion). A drop to 3000 U/L was considered as severe hepatic IRI. SpO2 dropped within 2 minutes after WoT 13 minutes) had more complications with a higher Comprehensive Complication Index during hospital admission (43.0 versus 32.0; P = 0.002) and 90‐day graft loss (26% versus 6%; P = 0.01), compared with recipients with a short SpO2‐agonal (≤13 minutes). Furthermore, Cox proportional hazard modeling identified a long SpO2‐agonal as a risk factor for longterm graft loss (hazard ratio, 3.30; 95% confidence interval, 1.15‐9.48; P = 0.03). In conclusion, the onset of hypoxia during the agonal phase is related to the severity of hepatic IRI and postoperative complications. Therefore, SpO2

Acute kidney injury (AKI) is a common complication after liver transplantation and more frequently observed when high-risk grafts, such as donation after circulatory death (DCD) grafts are used. Our aim was to investigate the impact of the ischemia periods on development of AKI in DCD liver transplantation.We performed a 2-center retrospective study with 368 DCD graft-recipients. Donor warm ischemia time (DWIT) was divided into agonal phase (withdrawal of life support-cardiac arrest) and asystolic phase (cardiac arrest-start cold perfusion). We introduced a new period of warm ischemia: the combined warm ischemia time (combined WIT), which was defined as the sum of DWIT and recipient WIT.AKI was observed in 65% of the recipients and severe AKI in 41% (KDIGO stage 2/3). The length of combined WIT increased significantly with AKI severity: 61 minutes in recipients without AKI up to 69 minutes in recipients with the most severe form of AKI (P0.001). On multivariable analysis, increasing duration of the combined WIT was associated with an increased risk of developing severe AKI (odds ratio, 1.032 per every extra minute; 95% confidence interval, 1.014-1.051; P0.001). No relation was observed between length of cold ischemia time and severe AKI.Combined WIT is a newly defined period of warm ischemia in DCD liver transplantation. Length of combined WIT is associated with severity of postoperative AKI and should ideally not exceed 60 minutes.

Acute kidney injury (AKI) is a common postoperative complication after liver transplantation (LT). The occurrence of postoperative AKI after LT (Post-LT AKI) is associated with inferior patient and graft outcomes. Post-LT AKI is multifactorial in origin and has been related to the severity of liver disease, pre-LT renal dysfunction, graft quality, perioperative events and toxicity of immunosuppressive therapy. Furthermore it is thought that hepatic ischaemia reperfusion injury might be a driving force in the aetiology of post-LT AKI. Novel biomarkers for AKI are emerging and can be useful for early identification and characterization of AKI. There is a clear need for strategies aimed at preventing or treating post-LT AKI. Several pharmacological and non-pharmacological interventions have been studied, but so far failed to show any benefit in the prevention of post-LT AKI. Further studies are needed to develop and evaluate new interventions aimed at preventing post-LT AKI and improve patient outcomes.

The HFR is one of the most powerful and versatile Research Reactors in the world. Because of its strategical importance in the medical isotopes production, after 57 years of operating experience a Continued Safe Operations (CSO) mission will take place. The CSO project structure is based on the outline given in the IAEA draft Safety Guide SSG-48. The ageing management for the HFR is evaluated based on the IAEA Specific Safety Guide SSG-10. Moreover, the approach to the contents of the project is supported by the IAEA Draft Guidelines for Peer Review of “Ageing Management of Research Reactors for Continued Safe Operations”. The HFR is the second Research Reactor (RR) in the world to undergo this type of assessment and its experience will be extremely valuable in setting the international standards for CSO of research reactors. This paper describes the phases of the CSO project, the challenges encountered and the experience built during its development.

The reactor vessel of the High Flux Reactor (HFR) in Petten has been fabricated from Al 5154-O alloy grade with a maximum Mg content of 3.5 wt. %. The vessel experiences large amount of neutron fluences (notably at hot spot), of the order of 1027 n/m2, during its operational life. Substantial damage to the material’s microstructure and mechanical properties can occur at these high fluence conditions. To this end, a dedicated surveillance program: SURP (SURveillance Program) is executed to understand, predict and measure the influence of neutron radiation damage on the mechanical properties of the vessel material. In the SURP program, test specimens fabricated from representative HFR vessel material are continuously irradiated in two specially designed experimental rigs. A number of surveillance specimens are periodically extracted and tested to evaluate the changes in fracture toughness properties of the vessel as function neutron fluence. The surveillance testing results of test campaigns performed until 2015 were published previously in [1, 2]. The current paper presents fracture toughness and SEM results from the recent surveillance campaign performed in 2017. The fracture toughness specimen tested in this campaign received a thermal neutron fluence of 13.56 x1026 n/m2, which is ∼8.9 × 1025 n/m2 more than the thermal fluence received by the specimen tested in SURP 2015 campaign. These results from this campaign have shown no change in the fracture toughness from the values measured in the previous SURP campaign. The SEM observations are performed to study the fracture surface, to measure (by WDS) the transmutation Si formed near crack tip and to investigate various inclusions in the microstructure. SEM fracture surface investigation revealed a tortuous (bumpy) fracture surface constituting micro-scale dimples over majority of the fracture area. Islands of cleavage facets and secondary cracks have been observed as well. EDS analysis of various inclusions in the microstructure revealed presence of Fe rich inclusions and Mg-Si rich precipitates. Additionally, inclusions rich in Al-Mg-Cr-Ti were identified. Finally, changes in mechanical properties of Al 5154-O alloy with an increase in neutron fluence (or transmutation Si) are discussed in correlation with SEM microstructure and fracture morphology observed in SEM. TEM investigation of precipitate microstructure is ongoing and those results will be published in future.

For many nuclear power plants worldwide the operation period will be extended to 60 or 80 years in the coming years. As the operation period increases, the importance of knowledge of ageing mechanisms increases. In the framework of LTO there is limited knowledge about ageing and structural integrity of concrete structures. Knowledge about the strength of concrete structures and modelling thereof can be improved for a more complete knowledge base on ageing and degradation mechanism in nuclear facilities. Therefore, effort is required to improve the knowledge of concrete, material models and finite element modelling techniques as well as the assessment method. Recent developments have shown that ageing of civil structures receive more attention internationally (E.g. concrete degradation in bunker building Doel). Traditionally a large part of the research and development is focused on mechanical issues like piping and vessels. In order to increase the knowledge in the field of civil structures, the focus is on investigation of ageing of concrete and determining analysis methods. This paper focuses on the development of a practical assessment method for ageing of civil structures. As a first step information from international publications and other sources on civil structures ageing issues and management thereof, will be gathered. Well known international standards taking care of ageing phenomena based on problem areas and good practices are IGALL and GALL. IGALL and GALL contain information tables based on international experience. This is the starting point of the research in finding an assessment methodology for civil ageing management. It will be shown that IGALL and GALL contain very similar elements. Sorting on the AMPs results in a practical set of datasheets with summarizing information per AMP, including the underlying international experience. The datasheets are of limited size, presenting an helpful overview of the relevant structures or components, materials, environment and mechanisms. A method for civil ageing management is proposed which will be applied and developed in more detail in future research. Further research is necessary to develop a specific assessment methodology for concrete.

We have designed, fabricated and characterized an electro-absorption modulator integrated with generic technology on a semi-insulating substrate. The modulator operates at 64Gb/s with 6dB dynamic extinction ratio, a bias voltage of -2.2V and a voltage swing of 3.5V.

Background This was an 8-year follow-up of an RCT comparing ultrasound-guided foam sclerotherapy (UGFS) with high ligation and surgical stripping (HL/S) of the great saphenous vein (GSV). Methods Patients were randomized to UGFS or HL/S of the GSV. The primary outcome was the recurrence of symptomatic GSV reflux. Secondary outcomes were patterns of reflux according to recurrent varices after surgery, Clinical Etiologic Anatomic Pathophysiologic (CEAP) classification, Venous Clinical Severity Score (VCSS) and EuroQol Five Dimensions (EQ-5D™) quality-of-life scores. Results Of 430 patients originally randomized (230 UGFS, 200 HL/S), 227 (52·8 per cent; 123 UGFS, 103 HL/S) were available for analysis after 8 years. The proportion of patients free from symptomatic GSV reflux at 8 years was lower after UGFS than HL/S (55·1 versus 72·1 per cent; P = 0·024). The rate of absence of GSV reflux, irrespective of venous symptoms, at 8 years was 33·1 and 49·7 per cent respectively (P = 0·009). More saphenofemoral junction (SFJ) failure (65·8 versus 41·7 per cent; P = 0·001) and recurrent reflux in the above-knee GSV (72·5 versus 20·4 per cent; P = 0·001) was evident in the UGFS group. The VCSS was worse than preoperative scores in both groups after 8 years; CEAP classification and EQ-5D® scores were similar in the two groups. Conclusion Surgical stripping had a technically better outcome in terms of recurrence of GSV and SFJ reflux than UGFS in the long term. Long-term follow-up suggests significant clinical progression of venous disease measured by VCSS in both groups, but less after surgery. Registration number: NCT02304146 (http://www.clinicaltrials.gov).

We study the influence of electrical connection methods on the high speed performance of electro-absorption modulators (EAMs). We report the reflection parameter S 11 below −10dB up to 22GHz and 32GHz bandwidth for a mounted EAM chip-on-carrier, with input alumina transmission line and output termination load.

The reactor vessel of the High Flux Reactor (HFR) in Petten has been fabricated from Al 5154 - O alloy grade with a maximum Mg content of 3.5 wt. %. The vessel experiences large amount of neutron fluences (notably at hot spot), of the order of 1027 n/m2, during its operational life. Substantial damage to the material’s microstructure and mechanical properties can occur at these high fluence conditions. To this end, a dedicated surveillance program: SURP (SURveillance Program) is executed to understand, predict and measure the influence of neutron radiation damage on the mechanical properties of the vessel material. In the SURP program, test specimens fabricated from representative HFR vessel material are continuously irradiated in two specially designed experimental rigs. A number of surveillance specimens are periodically extracted and tested to evaluate the changes in fracture toughness properties of the vessel as a function neutron fluence. The surveillance testing results of test campaigns performed until 2009 were already published by N. V. Luzginova et. al. [1]. The current paper presents results from the two recent surveillance campaigns performed in 2014 and 2015. The fracture toughness and tensile testing results are reported. Changes in mechanical properties of Al 5154-O alloy with an increase in neutron fluence are discussed in correlation with the irradiation damage microstructure observed in TEM and the fracture morphology observed in SEM. The HFR surveillance testing results are compared to the historically published results on irradiated aluminum alloys and conclusions about the evolution of embrittlement trends in relation with irradiation induced damage mechanisms in HFR vessel are drawn at the end.

For many nuclear power plants worldwide the operation period will be extended from 40 to 60 years. As the operation period increases the knowledge of ageing mechanisms like fatigue becomes more important. Knowledge of the influence of the environment is crucial, since environmental fatigue results in a modification of the existing fatigue assessment method and possible reduction of the fatigue life. This paper contains the results of an extended literature survey of environmentally assisted fatigue in nuclear power plants. It describes the current status and developments in the world. The main regulatory rules, guidelines and methods from the US, Germany, Japan, Finland, France and Czechia are presented. Although the general trend towards a more uniform approach worldwide has begun, considerable different approaches for incorporating the effect of coolant water environment exist. The most common approach is the incorporation of an environmental fatigue correction factor (Fen) in the fatigue derivation of the cumulative usage factor. The Fen formulas and the S-N fatigue curves differ but the general equations are: Fen = Nair/Nwater and CUF = Σ Upartial * Fenpartial Alternatives like using fatigue curves including the environmental effects, using threshold criteria and calculation of an allowable Fen based on testing, are described. Research and material tests are on-going and subject of international development. An overview of the current international state-of-the-art is presented.

Acute kidney injury (AKI) is frequently observed after donation after brain death (DBD) liver transplantation (LT) and associated with impaired recipient survival and chronic kidney disease. Hepatic ischemia/reperfusion injury (IRI) is suggested to be an important factor in this process. The postreperfusion syndrome (PRS) is the first manifestation of severe hepatic IRI directly after reperfusion. We performed a retrospective study on the relation between hepatic IRI and PRS and their impact on AKI in 155 DBD LT recipients. Severity of hepatic IRI was measured by peak postoperative AST levels and PRS was defined as >30% decrease in MAP ≥1 min within 5 min after reperfusion. AKI was observed in 39% of the recipients. AKI was significantly more observed in recipients with PRS (53% vs. 32%; P = 0.013). Median peak AST level was higher in recipients with PRS (1388 vs. 771 U/l; P < 0.001). Decrease in MAP after reperfusion correlated well with both severity of AKI (P = 0.012) and hepatic IRI (P < 0.001). Multiple logistic regression identified PRS as an independent factor for postoperative AKI (OR 2.28; 95% CI 1.06-4.99; P = 0.035). In conclusion, PRS reflects severe hepatic IRI and predicts AKI after DBD LT. PRS immediately after reperfusion is an early warning sign and creates opportunities to preserve postoperative renal function.

Potato is one of the many important hosts for the root‐knot nematodes Meloidogyne chitwoodi and M. fallax that can infest roots as well as tubers. In the latter they may cause surface galls and necrotic spots below the skin. In the EU these pathogens are categorized as quarantine organisms and are therefore regulated. Phytosanitary measures (PMs) are implemented and one aspect involves diagnostic procedures to detect these pathogens. To date, visual screening of external and internal symptoms is combined with the specific identification of these pests, either through microscopy, biochemical or molecular tests. A disadvantage of all these tests is the requirement of the prior extraction of nematodes from the tubers, which is not suitable for high‐throughput screening. This paper describes the MeloTuber Test developed to simultaneously detect M. chitwoodi and M. fallax by triplex real‐time TaqMan®PCR directly in secondary potato tuber peelings. DNA extraction is carried out in a 96‐well plate of pooled secondary peelings from one hundred tubers. The analytical sensitivity is such that a single female can be readily detected in such a sample size. The validation data, described here, prove the suitability of this molecular test for the detection of M. chitwoodi and M. fallax in large scale screening tests.

To the Editor: Balamuthia mandrillaris is a free-living ameba that has a worldwide distribution in soil and was first reported in 1990 (1). Approximately 200 B. mandrillaris meningoencephalitis cases have been described, mostly from warm climate areas in South America. Its prevalence in the United States is estimated to be 1 case/year (2). However, B. mandrillaris meningoencephalitis has not been reported in Africa, and only 4 cases have been reported in Europe (3–6). Transmission occurs through the respiratory tract or the skin or by organ transplant, and the incubation period varies from weeks to months after primary infection (7). After an indolent, subacute phase with aspecific symptoms, the amebae invade the central nervous system, and illness rapidly progresses, leading almost invariably to death (7). Because B. mandrillaris is difficult to detect in soil, its specific geographic distribution around the world is unknown and is estimated on the basis of where illnesses have been reported (7). This report addresses fatal B. mandrillaris meningoencephalitis in a woman from the Netherlands who had visited The Gambia. In December 2013, a previously healthy 61-year-old white woman in the Netherlands sought care for fever, headaches, and muscle pains she had experienced for 1 week. That year, she had traveled 4 times to The Gambia, the last visit being 1 month before her hospitalization (Technical Appendix Table 1). After she returned from her visit in September 2013, fatigue, diarrhea, fever, and pustular skin lesions on her back and lower extremities developed. A wound swab culture showed Staphylococcus aureus, for which she was treated successfully with oral clarithromycin and topical fucidin ointment. On admission in December, her physical and neurologic examination results were unremarkable. Malaria was excluded; because of persisting headaches, a cerebral computed tomography scan without contrast was performed but showed no abnormalities. In the following days, high fevers, altered mental status, and nuchal rigidity without focal neurologic deficits developed. Cerebrospinal fluid (CSF) examination showed mononuclear pleocytosis, highly elevated protein levels, and low glucose levels (Technical Appendix Table 2). Serial cerebral computed tomography and magnetic resonance imaging scans showed development of an asymmetric hydrocephalus and diffuse leptomeningeal and subependymal contrast enhancement, especially around the brainstem, without signs of intracerebral mass lesions (Technical Appendix Figure). Presumed diagnosis was tuberculous meningitis, and she was treated with tuberculostatic drugs (isoniazid, rifampin, pyrazinamide, and ethambutol) combined with intravenous acyclovir, ceftriaxone, and co-trimoxazole for other infectious causes of meningoencephalitis. Despite external lumbar and ventricular (both lateral ventricles and fourth ventricle) CSF drainage, her neurologic condition deteriorated. Multiple cranial nerve palsies developed, and she became comatose and died 11 days after admission. Informed consent for postmortem examination was obtained, and macroscopic pathologic examination showed uncal and cerebellar herniation caused by increased intracranial pressure. Microscopic brain tissue examination showed signs of acute granulomatous inflammation, multiple hemorrhagic infarctions, and angiitis in the presence of numerous amebic trophozoites and cysts (Figure), which showed granulomatous hemorrhagic necrotic amebic meningoencephalitis. Real-time PCR and subsequent sequencing on brain biopsy and CSF specimens showed B. mandrillaris to be the causative ameba (8,9). Figure Postmortem pathologic findings for woman in the Netherlands who died of Balamuthia mandrillaris meningoencephalitis after returning from travel to The Gambia. A) Macroscopic coronal central section scan showing hemorrhagic necrotizing lesions of the subependymal, ... The infection could have been acquired in The Gambia or the Netherlands because the patient had intensive soil contact in The Gambia, where she frequently cultivated land, and in the Netherlands, where she worked in glass horticulture. She may have been infected through the skin after contact with contaminated soil, but her skin lesions were atypical for B. mandrillaris, and postmortem examinations failed to identify B. mandrillaris except in the central nervous system. The lack of reported B. mandrillaris cases from Africa might indicate a low number of postmortem examinations and little access to advanced diagnostics, rather than a low environmental prevalence of B. mandrillaris. The few reported cases in Europe might be related to lack of awareness and to clinical signs and symptoms that mimic tuberculous meningitis: a lymphocytic pleocytosis with an elevated protein level and a low glucose level in CSF, together with a hydrocephalus and subependymal and leptomeningeal contrast enhancement on magnetic resonance imaging (10). Also, B. mandrillaris meningoencephalitis imaging findings are often nonspecific, including cerebral edema, hydrocephalus, multiple space-occupying and ring-enhancing lesions, leptomeningeal enhancement, or formation of mycotic aneurysms (2). Furthermore, amebic trophozoites are seldom detected in CSF by microscopy (2,3). Consequently, B. mandrillaris meningoencephalitis could be underdiagnosed, especially where this infection has no or only sporadic reports. B. mandrillaris should be considered in refractory or unexplained cases of meningoencephalitis, even outside the Americas and in immunocompetent patients. Detecting B. mandrillaris by PCR in CSF seems most likely to enable early diagnosis and timely treatment. However, appropriate therapy is not well defined; success has been sparsely reported with the simultaneous use of azoles, flucytosine, pentamidine, sulfazidine, macrolide antimicrobial drugs, phenothiazines, and miltefosine (2,7,10). Technical Appendix. Timeline of relevant events, laboratory investigations during hospitalization, and imaging results for Dutch traveler who died of Balamuthia mandrillaris meningoencephalitis after returning from The Gambia. Click here to view.(248K, pdf)

In this study, longitudinal cohort-sequential latent growth modeling was used to determine the effects of (a) socioeconomically mixed preschool and kindergarten classrooms, (b) the implementation of an education program aiming to accelerate socioeconomically disadvantaged children's emergent academic skills, and (c) the amount of teacher-managed academic activities on 3- to 6-year-old disadvantaged children's emergent literacy and math skills (n = 91). The results indicate that disadvantaged children in mixed preschool and kindergarten classrooms gained more in literacy and math than disadvantaged children in targeted classrooms. The results also indicate that the use of a special education program to promote disadvantaged children's emergent literacy and math was not effective, probably because of a lack of implementation fidelity. However, the extent to which teachers engaged in the kind of activities that were intended by the education program, in particular frequent initiation and guidance of language, literacy, and math activities, was significantly related to disadvantaged children's outcomes.

miRNAs have emerged as promising biomarkers because of their association with cell stress and diseases and their easy detection and stability in many body fluids. Because of the sensitivity, the method of choice to detect miRNAs is quantitative RT-PCR (RT-qPCR). Therapeutics, in particular circulating anticoagulants, are notorious for their inhibitory effect on RT-qPCR–based measurements. The effect of heparin contamination on inhibition of RT-qPCR from miRNAs isolated from urine has, however, never been investigated. We obtained urine samples from healthy controls and from heparinized patients undergoing major surgery (live kidney donation or liver transplantation) (n = 27). Samples were spiked with synthetic miRNAs to monitor RNA loss during workup, and levels of endogenous and spiked-in miRNAs were quantified by RT-qPCR. Endogenous miRNAs in urine were protected from degradation, but levels differed substantially within surgery groups. Variability in detection levels of spiked-in miRNAs was low in nonhospitalized controls, but was high in both surgery groups, and the difference in miRNA levels correlated well with the heparin concentration in urinary samples. Treatment of urinary RNA with heparinase I during RT-qPCR strongly reduced this variation in a dose-dependent manner. Heparinase I should therefore be considered as standard step for detection of miRNA in urine from hospitalized individuals.

Background: Perceived control is thought to play an important role in the development and maintenance of anxiety disorders in children. The objective of the present study was to further investigate the Perceived Control Implicit Association Procedure (IAP, Hogendoorn et al., 2008) as an indirect measure of perceived control in children.Methods: The IAP was completed by 136 anxiety disordered children (aged 8-18 years old, M = 12.51) and 31 non-selected children (8-15 years old. M = 11.65). A second control group of 38 non-selected children (aged 8-18 years old, M = 12.08) was used to validate the pictorial stimuli in the computer task.Results: First, children were able to correctly classify the pictures into Control and No control categories. Second, as predicted, anxious children reported less perceived control than the control group on both the direct measure (the ACQ-C) and the indirect measure (IAP). For the No Control score however, this was only the case for children younger than twelve years old. Third, test-retest correlation in the anxious group was fair to good (ICCs .57.58).Conclusions: These results suggest that the perceived control IAP is still quite experimental, but could be an interesting departure point for future research on perceived control in children. (c) 2012 Elsevier Ltd. All rights reserved.

Descriptions of critical moments of coaching, defined as exciting, tense, or significant moments from the time spent in the coaching conversation experienced by an executive coach and one of his clients, are analyzed and compared. Positioned within a tradition of analyzing critical-moment descriptions, the study makes use of data collected immediately after mutual coaching sessions. Both coach and client recorded one or more critical moments that had occurred in each coaching session, thereby providing data collected over time and allowing a direct comparison of the coach’s and the client’s critical-moment experiences. Results suggested that in almost half of the descriptions, the coach and the client referred to the same moments as being critical in the coaching sessions. Although the coach mostly described moments of self-doubt as being critical, the client focused on moments of new learning and a positive change in the coaching relationship. The results of this study were consistent with earlier work on critical moments in executive coaching. The study also offers an in-depth analysis of the coaching process over time, as experienced by both client and coach.

Background New minimally invasive treatment modalities, such as ultrasound-guided foam sclerotherapy (UGFS), are becoming more popular. In a multicentre randomized controlled non-inferiority trial, the effectiveness and costs of UGFS and surgery for treatment of the incompetent great saphenous vein (GSV) were compared. Methods Patients with primary great saphenous varicose veins were assigned randomly to either UGFS or surgical stripping with high ligation. Recurrence, defined as reflux combined with venous symptoms, was determined on colour duplex scans at baseline, 3 months, 1 year and 2 years after initial treatment. Secondary outcomes were presence of recurrent reflux (irrespective of symptoms), reduction of symptoms, health-related quality of life (EQ-5D™), adverse events and direct hospital costs. Results Two hundred and thirty patients were treated by UGFS and 200 underwent GSV stripping. The 2-year probability of recurrence was similar in the UGFS and surgery groups: 11·3 per cent (24 of 213) and 9·0 per cent (16 of 177) respectively (P = 0·407). At 2 years, reflux irrespective of venous symptoms was significantly more frequent in the UGFS group (35·0 per cent) than in the surgery group (21·0 per cent) (P = 0·003). Mean(s.d.) hospital costs per patient over 2 years were €774(344) per patient for UGFS and €1824(141) for stripping. Conclusion At 2-year follow-up, UGFS was not inferior to surgery when reflux associated with venous symptoms was the clinical outcome of interest. UGFS has the potential to be a cost-effective approach to a common health problem. Registration numbers: NCT01103258 (http://www.clinicaltrials.gov) and NTR654 (http://www.trialregister.nl).

Recent functional magnetic resonance imaging (fMRI) studies addressing healthy subjects point towards posterior parietal cortex (PPC) involvement in episodic memory tasks. This is noteworthy, since neuropsychological studies usually do not connect parietal lesions to episodic memory impairments. Therefore an inventory of the possible factors behind this apparent paradox is warranted. This review compared fMRI studies which demonstrated PPC activity in episodic memory tasks, with findings with studies of patients with PPC lesions. A systematic evaluation of possible explanations for the posterior parietal paradox indicates that PPC activation in fMRI studies does not appear to be attributable to confounding cognitive/psychomotor processes, such as button pressing or stimulus processing. What may be of more importance is the extent to which an episodic memory task loads on three closely related cognitive processes: effort and attention, self-related activity, and scene and image construction. We discuss to what extent these cognitive processes can account for the paradox between lesion and fMRI results. They are strongly intertwined with the episodic memory and may critically determine in how far the PPC plays a role in a given memory task. Future patient studies might profit from specifically taking these cognitive factors into consideration in the task design.

Deze studie onderzocht de effectiviteit van een cognitieve gedragstherapie gericht op het kind (kind-CGT) in vergelijking met een CGT voor het hele gezin (gezins-CGT). Opmerkelijke resultaten werden gevonden: direct na de behandeling was kind-CGT effectiever dan gezins-CGT. Drie maanden na de therapie werd geen verschil meer gevonden tussen beide condities. Gezins-CGT bleek ook geen meerwaarde te hebben wanneer ouders een angststoornis hadden, en evenmin wanneer het jonge kinderen betrof. Gezins-CGT was niet kosteneffectieverdan kind-CGT.

BackgroundIt has recently been suggested that auditory hallucinations are the result of a criterion shift when deciding whether or not a meaningful signal has emerged. The approach proposes that a liberal criterion may result in increased false-positive identifications, without additional perceptual deficit. To test this hypothesis, we devised a speech discrimination task and used signal detection theory (SDT) to investigate the underlying cognitive mechanisms.MethodSchizophrenia patients with and without auditory hallucinations and a healthy control group completed a speech discrimination task. They had to decide whether a particular spoken word was identical to a previously presented speech stimulus, embedded in noise. SDT was used on the accuracy data to calculate a measure of perceptual sensitivity (Az) and a measure of response bias (β). Thresholds for the perception of simple tones were determined.ResultsCompared to healthy controls, perceptual thresholds were higher and perceptual sensitivity in the speech task was lower in both patient groups. However, hallucinating patients showed increased sensitivity to speech stimuli compared to non-hallucinating patients. In addition, we found some evidence of a positive response bias in hallucinating patients, indicating a tendency to readily accept that a certain stimulus had been presented.ConclusionsWithin the context of schizophrenia, patients with auditory hallucinations show enhanced sensitivity to speech stimuli, combined with a liberal criterion for deciding that a perceived event is an actual stimulus.

Objective: Two methods for predicting remissions in obsessive–compulsive disorder (OCD) treatment are evaluated. Y-BOCS measurements of 88 patients with a primary OCD (DSM-III-R) diagnosis were performed over a 16-week treatment period, and during three follow-ups. Method: Remission at any measurement was defined as a Y-BOCS score lower than thirteen combined with a reduction of seven points when compared with baseline. Logistic regression models were compared with a Cox regression for recurrent events model. Results: Logistic regression yielded different models at different evaluation times. The recurrent events model remained stable when fewer measurements were used. Higher baseline levels of neuroticism and more severe OCD symptoms were associated with a lower chance of remission, early age of onset and more depressive symptoms with a higher chance. Conclusion: Choice of outcome time affects logistic regression prediction models. Recurrent events analysis uses all information on remissions and relapses. Short- and long-term predictors for OCD remission show overlap.