Search

Background Most staff stay healthy during humanitarian work, although some worsen. Mean scores on health indicators may be masking individual participants struggling with health issues. Aims To investigate different field assignment-related health trajectories among international humanitarian aid workers (iHAWs) and explore the mechanisms used to stay healthy. Method Growth mixture modelling analyses for five health indicators using pre-/post-assignment and follow-up data. Results Among 609 iHAWs three trajectories (profiles) were found for emotional exhaustion, work engagement, anxiety and depression. For post-traumatic stress disorder (PTSD) symptoms, four trajectories were identified. The 'healthy/normative' trajectory had the largest sample size for all health indicators (73-86%). A stable (moderate) 'ill health' trajectory was identified for all health indicators (7-17%), except anxiety. An 'improving' trajectory was found for PTSD and anxiety symptoms (5-14%). A minority of staff (4-15%) worsened on all health indicators. Deterioration continued for PTSD, depressive symptoms and work engagement 2 months post-assignment. A strong sense of coherence was associated with higher odds of belonging to the 'healthy' trajectory. Female biological sex was associated with higher odds of belonging to the 'worsening' depression and anxiety trajectories. Extended duration of field assignment was related to higher odds of belonging to the 'worsening' depressive symptoms trajectory. Conclusions Most iHAWs stayed healthy during their assignment; a stable 'ill health' trajectory was identified for most health indicators. Sense of coherence is an important mechanism for understanding the health of all iHAWs in the different health trajectories, including the 'healthy' profile. These findings give new possibilities to develop activities to prevent worsening health and help strengthen iHAWs' ability to remain healthy under stress

To date, there have been no cohort studies of sexual harassment incidence and its relation to mental health within humanitarian field-workers. Research among numerous occupations suggests an association between workplace sexual harassment and several health complaints. This study examined the incidence and severity of sexual harassment and its association with changes in mental health in a cohort of international humanitarian aid field-workers (iHAWs). Four hundred and seventy-eight iHAWs filled in questionnaires about sexual harassment, depression, anxiety, and Post-Traumatic Stress Disorder (PTSD) as part of a larger study on health and well-being. Six percent of male and 18% of female iHAWs reported experiencing sexual harassment during their latest field assignment, with most reporting low levels of nonphysical forms of sexual harassment. Sexual harassment was predictive of negative changes in both depression and anxiety symptom severity between before and after an assignment for females; for males, it predicted negative changes in PTSD symptom severity. Sexual harassment did not predict utilization of mental healthcare services within 2 months after the end of assignment. The current findings are the first figures derived from a representative sample of iHAWs on the incidence of sexual harassment during a field assignment and show sexual harassment to be a relatively common and present issue. The findings are mostly in line with the extant literature and underscore the importance of attending to the issue of sexual harassment in the humanitarian sector.

1. Salt marshes fronting coastal structures, such as seawalls and dikes, may offer important ecosystem-based coastal defence by reducing the wave loading and run-up levels during storms. We question (i) how the long-term salt marsh development in the Dutch Wadden Sea relates to the tidal-flat foreshore bathymetry and (ii) how the wave run-up onto dikes, which enhances the risk of dike failure, depends on foreshore bathymetry, the presence/absence of marshes, marsh vegetation properties, tidal range and wind exposure. 2. We analysed 15 years of vegetation and bathymetry maps along the entire Dutch Wadden Sea coast, in combination with detailed process-based measurements at five locations during 3 years, to understand where salt marshes naturally form and what features determine their contribution to coastal protection. 3. The horizontal extent of marshes along the dikes remained relatively stable over the past decade. The presence of marshes was associated with higher elevations of adjacent tidal flats (above ~0.5 m NAP), while landward-directed marsh retreat was associated with surface erosion of the fronting tidal flats. 4. Wave run-up during storms was lower at sites with wider marshes and higher foreshore elevations. This was attributed to the marsh attenuation effect, which led to a reduction in wave heights at the dike toe. As the tidal range varies across the Dutch Wadden Sea, areas to the East with generally higher water levels experienced higher wave run-up. 5. Synthesis and applications. We found that (i) marshes, where present, effectively protected the dikes from wave loading and (ii) the sites where marshes typically do not develop spontaneously were the most vulnerable to high wave run-up. This catch-22 problem implies that increasing reliance on nature-based coastal defences along soft-bottom coasts may require human interventions to stimulate marsh formation at the locations where it is most needed. Alternatively, ‘hard engineering’ solutions m

Background: Early detection of recurrent or progressive HCC remains the strongest prognostic factor for survival. Dual tracer PET/CT imaging with [11C]CH and [18F]FDG can further increase detection rates as both tracers entail different metabolic pathways involved in HCC development. We investigated dual-tracer PET/CT in clinical decision making in patients suspected of recurrent or progressive HCC. All HCC patients who underwent both [11C]CH and [18F]FDG PET/CT in our institute from February 2018 to December 2021 were included. Both tracer PET/CT were within 4 weeks of each other with at least 6-month follow-up. Patients underwent dual tracer PET/CT because of unexplained and suspicious CT/MRI or sudden rise of serum tumour markers. A detected lesion was considered critical when the finding had prognostic consequences leading to treatment changes. Results: Nineteen patients who underwent [11C]CH and [18F]FDG PET/CT were included of which all but six patients were previously treated for HCC. Dual-tracer critical finding detection rate was 95%, with [18F]FDG 68%, and [11C]CH 84%. Intrahepatic HCC recurrence finding rate was 65% for both tracers. [18F]FDG found more ablation site recurrences (4/5) compared to [11C]CH (2/5). Only [11C]CH found two needle tract metastases. Both tracers found 75% of the positive lymph nodes. Two new primary tumours were found, one by [18F]FDG and both by [11C]CH. Conclusions: Our study favours a dual-tracer approach in HCC staging in high-risk patients or when conventional imaging is non-conclusive.

Objective: Subjective well-being is a crucial variable for mental health practitioners. This study examines the influence of therapists' attachment dimensions and self-reported reflective functioning on their perceived well-being. Further, it examines if reflective functioning mediates the association between attachment insecurity and well-being. Method: A total of 416 experienced psychotherapists were enrolled in this cross-sectional study, and completed self-report measures of attachment insecurity, reflective functioning, and well-being. We tested the hypothesized mediation model with path analysis that examined indirect effects. Results: Both attachment anxiety and avoidance dimensions had a significant negative association with perceived well-being with small to medium effects. "Certainty" in reflective functioning had a small positive effect on therapist well-being. Reflective functioning mediated the association between insecure attachment dimensions and well-being, suggesting that therapist's lower ability to mentalize may partially account for the effects of higher attachment insecurity on lower well-being. Conclusion: The well-being of psychotherapists with greater insecure attachment may deserve special attention, and therapists' mentalizing capacities may be targeted by researchers and trainers as a core ability to be cultivated in order to preserve therapists' professional and personal resources.

Background: Recipient selection for liver transplantation in hepatocellular carcinoma (HCC) is based primarily on criteria affecting the chance of long-term success. Here, the relationship between pretransplant bridging therapy and long-term survival was investigated in a subgroup analysis of the SiLVER Study. Methods: Response to bridging, as defined by comparison of imaging at the time of listing and post-transplant pathology report, was categorized into controlled versus progressive disease (more than 20 per cent tumour growth or development of new lesions). Results: Of 525 patients with HCC who had liver transplantation, 350 recipients underwent pretransplant bridging therapy. Tumour progression despite bridging was an independent risk factor affecting overall survival (hazard ratio 1.80; P=0.005). For patients within the Milan criteria (MC) at listing, mean overall survival was longer for those with controlled versus progressive disease (6.8 versus 5.8 years; P<0.001). Importantly, patients with HCCs outside the MC that were downsized to within the MC before liver transplantation had poor outcomes compared with patients who never exceeded the MC (mean overall survival 6.2 versus 6.6 years respectively; P=0.030). Conclusion: Patients with HCCs within the MC that did not show tumour progression under locoregional therapy had the best outcomes after liver transplantation. Downstaging into the limits of the MC did not improve the probability of survival. Prognostic factors determining the long-term success of liver transplantation in patients with hepatocellular carcinoma are still under discussion. A subgroup analysis of the SiLVER trial showed that disease control under bridging therapy is strongly associated with improved prognosis in terms of overall survival. However, in tumours exceeding the limits of the Milan criteria, downstaging did not restore the probability of survival compared with that of patients within the Milan criteria.

The production of base chemicals such as olefins and aromatics from synthesis gas is of great interest from both an academic and an industrial point of view. We prepared a bulk iron Fischer Tropsch catalyst promoted with potassium capable of converting synthesis gas to olefins and combined it with an H-ZSM-5 zeolite to convert the formed olefins to aromatics on the zeolite acid sites. All experiments were performed in stacked bed mode to avoid migration of potassium promoters from the iron catalyst to the zeolite, which can deactivate acid sites in the zeolite. Operating at a pressure of 20 bar and temperatures between 250 °C and 300 °C instead of high temperatures of 300−350 °C led to a methane selectivity of only 7–14 %C. Olefins in the range of C4–C8 were converted to aromatics in the initial section of the zeolite bed, while further into the zeolite bed C2-C3 olefins oligomerized to longer olefins and alkylated light aromatics forming heavier aromatic hydrocarbons. Investigation of the influence of CO conversion on the aromatization of olefins showed a maximum in aromatic selectivity (excluding CO2) of 18 %C at medium CO conversion (XCO = 26–47 %). This work provides detailed insight into the chemical events that occur in bifunctional catalyst beds and can contribute to the development of an industrial process to convert synthesis gas to aromatics in a single reactor.

With the motivation of investigating the replicability and Skills (FIS) performance task beyond Anglophone countries, a transferability of the findings employing the Facilitative Interpersonal set of Dutch FIS clips have been scripted and recorded. In this study the psychometric properties of the Dutch clips was tested. Furthermore, an additional set of FIS clips portraying a non-challenging client-therapist interaction was tested. 369 psychology students rated the interpersonal impact (IMI-C) and the affect (positive and negative affect schedule) displayed by the hypothetical client. Thirteen out of sixteen FIS clips were located in the same IMI-C quadrant as the US clips, indicating good content validity for all sets of FIS clips. Inter-rater reliability was reasonable for one set of Dutch language FIS clips (k=0.416). Visual inspection of quadrants showed the different character of the non-challenging set of FIS clips. The Dutch FIS clips are directly applicable for educational and research purposes.

Background The optimal treatment sequence for patients with rectal cancer and synchronous liver metastases remains unclear. The aim of this study was to evaluate the feasibility and effectiveness of short-course pelvic radiotherapy (5 x 5 Gy) followed by systemic therapy and local treatment of all tumour sites in patients with potentially curable stage IV rectal cancer in daily practice.Methods This was a retrospective study performed in eight tertiary referral centres in the Netherlands. Patients aged 18 years or above with rectal cancer and potentially resectable liver +/- extrahepatic metastases, treated between 2010 and 2015, were eligible. Main outcomes included full completion of treatment schedule, symptom control and survival.Results In total, 169 patients were included with a median follow-up of 49 center dot 5 (95 pr cent c.i. 43 center dot 6 to 55 center dot 6) months. The completion rate for the entire treatment schedule was 65 center dot 7 per cent. Three-year progression-free survival and overall survival (OS) rates were 24 center dot 2 (95 per cent c.i. 16 center dot 6 to 31 center dot 6) and 48 center dot 8 (40 center dot 4 to 57 center dot 2) per cent respectively. Median OS of patients who responded well and completed the treatment schedule was 51 center dot 5 months, compared with 15 center dot 1 months for patients who did not complete the treatment (P <0 center dot 001). Adequate symptom control of the primary tumour was achieved in 87 center dot 0 per cent of all patients.Conclusion Multimodal treatment is palliative in most patients, and associated with good survival rates in those able to complete the schedule.

Objective: The aim of this study was to evaluate the survival benefit of sirolimus in patients undergoing liver transplantation (LT) for hepatocellular carcinoma (HCC) (exploratory analysis of the SiLVER-trial). Summary and Background Data: Patients receiving LT) for HCC are at a high risk for tumor recurrence. Calcineurin inhibitors have shown evidence to promote cancer growth, whereas mammalian target of rapamycin (mTOR) inhibitors like sirolimus have anticancer effects. In the SiLVER-trial (Clinicaltrials.gov:NCT00355862), the effect of sirolimus on the recurrence of HCC after LTwas investigated in a prospective randomized trial. Although the primary endpoint of improved disease-free survival (DFS) with sirolimus was not met, outcomes were improved for patients in the sirolimus-treatment arm in the first 3 to 5 years. To learn more about the key variables, a multivariate analysis was performed on the SiLVER-trial data. Patients and Methods: Data from 508 patients of the intention-to-treat analysis were included in exploratory univariate and multivariate models for overall survival (OS), DFS and a competing risk analysis for HCC recurrence. Results: Sirolimus use for >= 3 months after LT for HCC independently reduced the hazard for death in the multivariate analysis [hazard ratio (HR): 0.7 (95% confidence interval, CI: 0.52-0.96, P = 0.02). Most strikingly, patients with an alpha-fetoprotein (AFP) >= 10 ng/mL and having used sirolimus for >= 3 months, benefited most with regard to OS, DFS, and HCC-recurrence (HR: 0.49- 0.59, P = 0.0079- 0.0245). Conclusions: mTOR-inhibitor treatment with sirolimus for >= 3 months improves outcomes in LT for HCC, especially in patients with AFP-evidence of higher tumor activity, advocating particularly for mTOR inhibitor use in this subgroup of patients. Clinical Trial Registration: EudraCT: 2005-005362-36 Clinicaltrials.gov: NCT00355862.