[Forensic (flexible) assertive community treatment: client characteristics and treatment outcomes]. / Forensische (flexibele) assertive community treatment ((F)ACT): cliëntkenmerken en behandelresultaten.

BACKGROUND: (Flexible) Assertive community treatment ((f)act) is applied increasingly to forensic psychiatric clients. However, evidence about the effectiveness of forensic (f)act is scanty. AIM: To investigate to what extent (subgroups of) clients receiving care from forensic (f)act teams show, after a year, changes in their social and psychological functioning and are subjected to fewer justicial outcome measures. METHOD: Between 2009 and 2011, eight forensic (f)act teams collected, at two measurement moments separated by an average of 12 months, data relating to client characteristics and outcomes of care. The study involved 202 clients. RESULTS: After a year clients showed significant improvements in psychological and social functioning, and had fewer confrontations with the police and the law. They were detained less often and for shorter periods and were considered to be less likely to reoffend. The number of admissions to mental health care and to addiction and forensic care remained constant. CONCLUSION: Clients with a psychiatric disorder and likely to display criminal behaviour showed improvement while being treated by forensic (f)act teams. Further research is needed to prove whether forensic (f)act treatment will have the desired effects in the longer term and will enjoy the status of being regarded as evidence based practice.

[Risk assessment of violent women: development of the 'Female Additional Manual' (FAM)]. / Risicotaxatie van geweld bij vrouwen: ontwikkeling van de 'Female Additional Manual' (FAM).

BACKGROUND: Violence perpetrated by women is a growing problem. Research has shown that the risk factors associated with women differ from those associated with men and that the risk assessments currently in use are not adequate for predicting violence in women. AIM: To develop a clinically relevant, useful tool for an accurate, gender-sensitive assessment of risk of violent behaviour in women and to offer guidelines for risk management in women. METHOD: On the basis of literature research, clinical expertise and the results of a pilot study, we adapted the much-used 'Historical Clinical Risk management-20 (HCR-20) for use with female (forensic) psychiatric patients who have a record of violence towards other people. RESULTS: The 'Female Additional Manual (FAM) supplemented and added value to the HCR-20 for assessing the risk of violent behaviour by women. CONCLUSION: The fam is a valuable addition to the currently available risk assessment tools in that it provides a more accurate gender-specific risk assessment with regard to female (forensic) psychiatric patients. Future research will have to further demonstrate the value of the FAM.

Evolution of the global internal dynamics of a living cell nucleus during interphase.

Progress in cellular biology based on fluorescent microscopy techniques, shows that the spatial organization of the nucleus is dynamic. This dynamic is very complex and involves a multitude of phenomena that occur on very different time and size scales. Using an original light scattering experimental device, we investigated the global internal dynamics of the nucleus of a living cell according to the phases of the cell cycle. This dynamic presents two different and independent kinds of relaxation that are well separated in time and specific to the phase of the cell cycle.

Modelling the spatial distribution of ammonia emissions in the UK.

Ammonia emissions (NH3) are characterised by a high spatial variability at a local scale. When modelling the spatial distribution of NH3 emissions, it is important to provide robust emission estimates, since the model output is used to assess potential environmental impacts, e.g. exceedance of critical loads. The aim of this study was to provide a new, updated spatial NH3 emission inventory for the UK for the year 2000, based on an improved modelling approach and the use of updated input datasets. The AENEID model distributes NH3 emissions from a range of agricultural activities, such as grazing and housing of livestock, storage and spreading of manures, and fertilizer application, at a 1-km grid resolution over the most suitable landcover types. The results of the emission calculation for the year 2000 are analysed and the methodology is compared with a previous spatial emission inventory for 1996.

Uncertainties and implications of applying aggregated data for spatial modelling of atmospheric ammonia emissions.

Ammonia emissions vary greatly at a local scale, and effects (eutrophication, acidification) occur primarily close to sources. Therefore it is important that spatially distributed emission estimates are located as accurately as possible. The main source of ammonia emissions is agriculture, and therefore agricultural survey statistics are the most important input data to an ammonia emission inventory alongside per activity estimates of emission potential. In the UK, agricultural statistics are collected at farm level, but are aggregated to parish level, NUTS-3 level or regular grid resolution for distribution to users. In this study, the Modifiable Areal Unit Problem (MAUP), associated with such amalgamation, is investigated in the context of assessing the spatial distribution of ammonia sources for emission inventories. England was used as a test area to study the effects of the MAUP. Agricultural survey data at farm level (point data) were obtained under license and amalgamated to different areal units or zones: regular 1-km, 5-km, 10-km grids and parish level, before they were imported into the emission model. The results of using the survey data at different levels of amalgamation were assessed to estimate the effects of the MAUP on the spatial inventory. The analysis showed that the size and shape of aggregation zones applied to the farm-level agricultural statistics strongly affect the location of the emissions estimated by the model. If the zones are too small, this may result in false emission "hot spots", i.e., artificially high emission values that are in reality not confined to the zone to which they are allocated. Conversely, if the zones are too large, detail may be lost and emissions smoothed out, which may give a false impression of the spatial patterns and magnitude of emissions in those zones. The results of the study indicate that the MAUP has a significant effect on the location and local magnitude of emissions in spatial inventories where amalgamated, zonal data are used.

[Ischemic mitral regurgitation: contributions of exercise echocardiography and new therapeutic perspectives]. / Insuffisance mitrale ischémique: apport de l'échocardiographie d'effort et nouvelles perspectives thérapeutiques.

The ischemic mitral regurgitation is defined by a left ventricular muscle disease affecting the function of normal mitral valve leaflets. This kind of mitral regurgitation is founded in about 20% of the ischemic cardiomyopathy and is attributed to the remodelling of the left ventricular shape. Its development is associated to a significantly worse prognosis. Frequently this ischemic mitral regurgitation will be associated to episode of acute heart failure decompensation. Its diagnosis is sometimes challenging as the degree of regurgitation might be extremely variable and affected by loading conditions. Echocardiography and especially exercise stress echocardiography has been demonstrated as an extremely powerful tool for its diagnosis and the prognostic evaluation. Its treatment should include the pharmacological treatment of the chonic heart failure and we are still waiting data in regard to the prognostic role of surgical mitral valvuloplastie. Works are still ongoing.

[Impact of the aetiology of cardiac failure on the correlations between electrical and mechanical asynchrony of the ventricle]. / Influence de l'étiologie de l'insuffisance cardiaque sur la corrélation entre asynchronismes électrique et mécanique dans le ventricule.

Cardiac resynchronisation therapy (CRT) is indicated in refractory cardiac failure with electrical asynchrony defined by QRS complexes > or =120 ms duration. The search for mechanical asynchrony is proposed for better selection of patients for CRT. Ischaemic and non-ischaemic cardiomyopathy do not necessarily show the same form of asynchrony. The authors studied the differences in correlation between electrical and mechanical asynchrony in these two patient populations. Fifty patients (34 dilated non-ischaemic and 16 ischaemic cardiomyopathy) in NYHA Classes III and IV, LVEF < 35%, consecutively implanted for CRT in 2004, were included. The trans-thoracic echocardiography, the ECG and clinical parameters (NYHA, 6 minute walk test, VO2 max) were compared. A non-significant improvement of the correlation between the aortic pre-ejection time and QRS duration was observed in the non-ischaemic group (r = 0.78, p< 0.0001) compared with the ischaemic cardiomyopathy group ( r = 0.56, p = 0.019). Similarly, intraventricular asynchrony seemed to be correlated with the duration of QRS in the non-ischaemic group (r = 0.65, p < 0.0001) unlike the ischaemic cardiomyopathy group (ns). Sub-group analysis of patients with QRS durations < 150 ms and > or =150 ms showed an electromechanical correlation irrespective of the QRS duration in the non-ischaemic group but this was only observed with the aortic pre-ejection time with QRS > or =150 ms in the ischaemic group. The authors conclude that there is a significant correlation between electrical and mechanical asynchrony in patients with non-ischaemic cardiomyopathy. This correlation only applies to intraventricular asynchrony with QRS durations > or =150 ms in the ischaemic group. A decision for CRT requires echocardiographic evaluation in ischaemic cardiomyopathy.

Optimal right ventricular pacing site in chronically implanted patients: a prospective randomized crossover comparison of apical and outflow tract pacing.

OBJECTIVES: To evaluate the long-term functional and hemodynamic effects of right ventricular outflow tract (RVOT) pacing by comparison with right ventricular apical (RVA) pacing. BACKGROUND: Acute studies have suggested that RVOT pacing could significantly improve cardiac performance in comparison with RVA pacing but no data are available in chronically implanted patients. METHODS: Sixteen patients with chronic atrial tachyarrhythmia and complete AV block were included. Left ventricular ejection fraction (LVEF) was > or =40% in ten and <40% in six. Patients were implanted with a standard DDDR pacemaker connected to two ventricular leads. A screw-in lead was placed at the RVOT and connected to the atrial port. A second lead was positioned at the RVA and connected to the ventricular port. Right ventricular outflow tract and RVA pacing was achieved by programming either the AAIR or the VVIR mode respectively. Four months later patients were randomized so as to undergo either RVOT or RVA pacing for three months according to a blind crossover protocol. Apart from the pacing mode, programming remained unchanged throughout the study. At the end of each period, NYHA class, LVEF, exercise time and maximal oxygen uptake were assessed. RESULTS: No significant difference was observed between the two modes for all the parameters analyzed. These identical results were observed in all patients globally, in patients with LVEF > or =40% as in those with LVEF <40%. CONCLUSIONS: Within the limits of this study, no symptomatic improvement or hemodynamic benefit was noted after three months of RVOT pacing, by comparison with RVA pacing.

The Modified-Modified Schober Test for range of motion assessment of lumbar flexion in patients with low back pain: a study of criterion validity, intra- and inter-rater reliability and minimum metrically detectable change.

PURPOSE: The objective was to estimate the psychometric properties of the Modified-Modified Schober Test (MMST). DESIGN: This study compared range of motion measurements of lumbar flexion in low back pain (LBP) patients using the MMST with measurements calculated on X-rays as the gold standard, and compared the measurements taken by two independent examiners. METHOD: This study was conducted at the main hospital in the Outaouais area, Quebéc, Canada. Thirty-one subjects with LBP from private and public clinics participated in the study. After a warm-up session, measurements with the MMST were taken in neutral position and an X-ray technician took an exposure in the same position. RESULTS: Pearson's correlation test (r) between measurements made with the MMST and the gold standard, intra-class correlation coefficient (ICC), minimum metrically detectable change (MMDC) and confidence interval (CI) were used to analyze the data. The MMST demonstrated moderate validity (r=0.67; 95%CI 0.44-0.84), excellent reliability (intra: ICC=0.95; 95%CI 0.89-0.97; inter: ICC=0.91; 95%CI 0.83-0.96) and a MMDC of 1 cm. CONCLUSIONS: In our sample of LBP patients, the MMST showed moderate validity but excellent reliability and MMDC.

[Early non-obstructive thrombosis of mechanical mitral valve prostheses]. / Thromboses non obstructives précoces des prothèses valvulaires mitrales mécaniques. Traitement par association prolongée héparine-AVK.

Transoesophageal echocardiography has shown a high incidence on non-obstructive thrombosis after mitral valve replacement with a mechanical prosthesis. The unpredictable outcome and the period during which the complication arises make treatment difficult. The aim of this study was to assess the tolerance and efficacy of the association of long-term heparin and oral anticoagulation, as recommended in this indication. All patients undergoing mitral valve replacement with a mechanical prosthesis between June 1999 and July 2001 were systematically included and studied by transoesophageal echocardiography in the immediate postoperative period. Those with non-obstructive thrombosis at least 5 mm in size were treated by heparin and oral coagulation until the thrombus disappeared on transoesophageal echocardiography. One hundred and fourteen patients undergoing 120 mitral valve replacements (6 reoperations) underwent transoesophageal echocardiography and non-obstructive thrombi measuring at least 5 mm were found on 26 occasions (21.7%). The association of heparin and oral coagulation was maintained for 7 to 115 days (average 20 days). No thromboembolic or haemorrhagic complications and no deaths were observed during this period. Two patients were treated with danaparoid and oral anticoagulation because of heparin-induced thrombocytopenia before the diagnosis. None of the patients died during follow-up (average 49 months); there were 4 recurrent non-obstructive thromboses, three of which were complicated by thromboembolic events with no sequellae in the first 8 months, again treated effectively with the association of heparin and oral anticoagulants; two cerebral embolic events without sequellae were observed without a demonstrable non-obstructive thrombus on transoesophageal echocardiography. The authors conclude that the association of heparin and oral anticoagulants seems well tolerated and effective in this small population and this would justify a large scale clinical trial.

Comparison of anti-HIV-1 ADCC reactivities in infected humans and chimpanzees.

Despite its shortcomings as a disease model, the chimpanzee is still the most relevant animal model for human immunodeficiency virus type 1 (HIV-1) infection. Previous studies have revealed qualitative differences between human and chimpanzee anti-HIV-1 responses. In this study, the development of specific anti-HIV-1 antibody-dependent cellular cytotoxic (ADCC) reactivities was evaluated in chronically infected chimpanzees and compared to the human response, because anti-HIV-1 ADCC represents a major component of anti-envelope cytolytic response found in infected patients. Ten HIV-1-infected chimpanzees up to 5 years after the infection were investigated. Anti-HIV-1 ADCC-directing antibodies were detectable in only three of 10 infected chimpanzees, and in these animals, activity was apparent only several months after the HIV infection. In some of the infected animals, ADCC reactivity against infected cells preceded reactivity against gp120-coated targets. When anti-gp120 ADCC-directing antibodies were apparent, they exhibited the same broad reactivity described in humans against different HIV isolates. The pattern of ADCC reactivities in infected chimpanzees is completely different from the well-characterized anti-gp120 cytotoxic reactivities present in HIV-1-infected patients. It is a relatively rare and late-occurring event that may have an important bearing on the lack of virus-induced pathogenesis in the chimpanzee model.

Electrocardiographic predictive factors of long-term clinical improvement with multisite biventricular pacing in advanced heart failure.

Biventricular pacing has recently been proposed for treating patients with drug refractory heart failure and intraventricular conduction delay. The purpose is to restore ventricular relaxation and contraction sequences as homogeneously as possible. The aim of this study was to determine if some factors could predict the long-term clinical effectiveness of that new treatment. This study included 26 patients, aged 66 +/- 7 years, with drug refractory heart failure and wide QRS. Patients were implanted with a biventricular pacemaker. The left ventricle was paced through a coronary sinus tributary. New York Heart Association functional class, exercise tolerance, and left ventricular (LV) ejection fraction were collected at baseline and after pacemaker implantation. Patients were divided into 2 groups: group I = responders; group II = nonresponders. QRS duration and axis at baseline and during biventricular pacing, interventricular conduction time, and LV and right ventricular lead positions were compared between the 2 groups. Group I patients (n = 19) had a mean reduction of 1.3 in functional class and an increase in peak oxygen consumption rate by a mean of 50%. The only parameter that differed between the 2 groups was the QRS duration during biventricular pacing, with a significantly shorter value in group I than in group II (154 +/- 17 vs 177 +/- 26 ms; p = 0.016). Thus, a positive response to biventricular pacing is correlated with the quality of electrical resynchronization. The optimal positions of the right and LV leads would be those that could induce the greatest shortening of QRS duration.

The impact of HIV-1 infection on phenotypic and functional parameters of cellular immunity in chimpanzees.

As a means of assessing the immunological impact of HIV infection in the chimpanzee, as well as the participation of the cellular components in the control of HIV infection in these animals, various aspects of cellular immunity were investigated in chronically HIV-infected chimpanzees. Eight HIV-1-infected chimpanzees were included in this study; two of them were infected for more than 5 years and six for nearly 3 years at the time of study. All of the chimpanzees received either 40 or 100 TCID50 of HTLV-IIIB. Circulating peripheral blood lymphocytes were studied by flow cytofluorimetric analysis in order to reveal possible alterations in the CD4:CD8 ratio, as well as in specific CD4+ and CD8+ cell subpopulations. Chronically infected chimpanzees did not present significant alterations in the percentage of CD4+ or CD8+ lymphocyte subsets. Interestingly, the CD8+/CD57+ cell subset was not detectable. The expression of markers for activation on circulating lymphocytes, usually higher in the HIV-infected patients, was not altered in infected animals. The functional aspects of specific anti-HIV-1 non-MHC and MHC-restricted cellular cytotoxic reactivities were also investigated. The results were compared with the findings in normal uninfected chimpanzees and in HIV-infected humans. Only one chimpanzee (881) developed a detectable, specific non-MHC-restricted anti-HIV-1- reactivity. Compared to that seen in humans, the ontogeny of this activity is delayed. Among the other infected chimpanzees, no specific anti-HIV cellular reactivities were detectable in the peripheral blood. In chimpanzees, HIV-1 infection evidently does not elicit the same strong cellular reactivity as that detected in infected patients. The absence of chronic cellular activation, despite continued viral replication, may highlight a key determinant in HIV-1-induced pathogenesis that is likewise absent in infected chimpanzees.

Pacemaker lead infection: echocardiographic features, management, and outcome.

OBJECTIVE: To compare transthoracic and transoesophageal echocardiography (TTE, TOE) in patients with permanent pacemaker lead infection and to evaluate the safety of medical extraction in cases of large vegetations. METHODS: TTE and TOE were performed in 23 patients with definite pacemaker lead infection. Seventeen patients without previous infection served as a TOE reference for non-infected leads. RESULTS: TTE was positive in seven cases (30%) whereas with TOE three different types of vegetations attached to the leads were visualised in 21 of the 23 cases (91%). Of the 20 patients with vegetations and lead culture, 17 (85%) had bacteriologically active infection. Left sided valvar endocarditis was diagnosed in two patients. In the control group, strands were visualised by TOE in five patients, and vegetations in none. Medical extraction of vegetations >/= 10 mm was performed in 12 patients and was successful in nine (75%) without clinical pulmonary embolism. After 31.2 (19.1) months of follow up (mean (SD)), all patients except one were cured of infection; three died from other causes. CONCLUSIONS: Combined with bacteriological data, vegetations seen on TOE strongly suggest pacemaker lead infection. Normal TTE examinations do not exclude this diagnosis because of its poor sensitivity. Medical extraction of even large vegetations appeared to be safe.

Calcification in a recent cerebral infarct--radiologic and pathologic correlation.

This 60 year old male developed a right hemiplegia and aphasia. A C.T. head scan showed a cerebral infarct which appeared hyperdense on a subsequent scan done 18 days after presentation. This was interpreted as indicating a hemorrhagic transformation resulting in discontinuation of anticoagulation therapy. At autopsy, the area of infarction in the left frontoparietal hemisphere appeared intensely green due to breakdown of the blood-brain barrier in the presence of jaundice. A striking finding on microscopy was the presence of calcium salts throughout the area of infarction but most prominent in the grey matter at the periphery of the infarct corresponding to the areas which appeared hyperdense on the CT head scan and stained intensely with bilirubin. There was no evidence of recent hemorrhage. This case illustrates that calcification can occur within weeks after the onset of a recent cerebral infarct and should be considered when interpreting the development of C.T. scan hyperdensity in recent cerebral infarcts.

Base-sequence-dependent sliding of proteins on DNA.

The possibility that the sliding motion of proteins on DNA is influenced by the base sequence through a base pair reading interaction, is considered. Referring to the case of the T7 RNA-polymerase, we show that the protein should follow a noise-influenced sequence-dependent motion which deviate from the standard random walk usually assumed. The general validity and the implications of the results are discussed.

Ammonia emission and deposition in Scotland and its potential environmental impacts.

The main source of atmospheric ammonia (NH3) in Scotland is livestock agriculture, which accounts for 85% of emissions. The local magnitude of emissions therefore depends on livestock density, type, and management, with major differences occurring in various parts of Scotland. Local differences in agricultural activities therefore result in a wide range of NH3 emissions, ranging from less than 0.2 kg N ha(-1) year(-1) in remote areas of the Scottish Highlands to over 100 kg N ha(-1) year-1 in areas with intensive poultry farming. Scotland can be divided loosely into upland and lowland areas, with NH3 emission being less than and more than 5 kg N ha(-1) year(-1), respectively. Many semi-natural ecosystems in Scotland are vulnerable to nitrogen deposition, including bogs, moorlands, and the woodland ground flora. Because NH3 emissions occur in the rural environment, the local deposition to sensitive ecosystems may be large, making it essential to assess the spatial distribution of NH3 emissions and deposition. A spatial model is applied here to map NH3 emissions and these estimates are applied in atmospheric dispersion and deposition models to estimate atmospheric concentrations of NH3 and NH4+, dry deposition of NH3, and wet deposition of NHx. Although there is a high level of local variability, modelled NH3 concentrations show good agreement with the National Ammonia Monitoring Network, while wet deposition is largest at high altitude sites in the south and west of Scotland. Comparison of the modelled NHx deposition fields with estimated thresholds for environmental effects ("critical loads") shows that thresholds are exceeded across most of lowland Scotland and the Southern Uplands. Only in the cleanest parts of the north and west is nitrogen deposition not a cause for concern. Given that the most intense effects occur within a few kilometres of sources, it is suggested that local spatial abatement policies would be a useful complement to traditional policies that mitigate environmental effects based on emission reduction technologies.

[Hemodynamics and M mode echocardiography of the consequences of ventriculo-atrial conduction in the human]. / Etude hémohynamique et échocardiographique TM des conséquences de la conduction ventriculo-auriculaire chez l'homme.

A haemodynamic and M mode echocardiographic study of 57 patients hospitalised for chronic, symptomatic 2nd or 2rd degree AV block was carried out after 3 periods of pacing, each lasting 2 hours : 1) sequential AV pacing ( SAV ) with a 200 ms delay, considered as the mode of reference; 2) sequential ventriculo-atrial pacing ( SVA ) with the same sequential delay, recreating equivalent conditions of 1/1 ventriculo-atrial conduction (VAC); 3) ventricular pacing (V) recreating complete AV dissociation ( CAVD ). The pacing rate was the same for each patient (89 +/- 9/min). In comparison with SAV , SVA caused much worse haemodynamic changes than V : large increases in mean atrial pressures (+161% and +64% in RAP and PCP respectively); "canon" atrial A waves which were poorly tolerated (mean amplitude 14 mmHg and 18 mmHg on the RA and PCP waves respectively); in some cases, a large fall in blood pressure was observed due to the failure of systemic resistances to increase and compensate for the constant decrease in pump function (mean reduction of 23% of cardiac index; 29% of LV work index). These changes are much more pronounced in diseased than in healthy hearts, especially in the presence of mitral or tricuspid regurgitation. Echocardiography showed the main cause of these haemodynamic changes to be a reduction in ventricular filling with significant reductions in LV systolic and diastolic dimensions, changes in the mitral valve echos (reduction in the opening and closing velocities, delayed closure), probably related to a decrease in transvalvular blood flow, and decreased regional contractility of the interventricular septum. These observations justify an increase in the indications of modes of pacing maintaining permanent atrio-ventricular sequence (VVI pacing at slow rates; AAI pacing, DVI or DDD pacing in cases of abnormal AV conduction with VAC, especially in cases of sick sinus syndrome with permanent bradycardia). These modes of pacing are particularly beneficial when the electrical abnormality is associated with a decompensated cardiac lesion, or with decreased ventricular compliance or mitral regurgitation.

[Myxoma of the tricuspid valve. Apropos of a case]. / Myxome de la valve tricuspide. A propos d'un cas.

The authors report the case of a chance echocardiographic finding of a tricuspid valve myxoma. Transesophageal echocardiography provided valuable complementary information concerning the precise location of the tumour. Tricuspid valve myxoma is a very rare condition: a review of the literature recensed 16 other cases. This case is of particular interest because of the associated pathological signs: erythemato-papular skin lesions which regresses after ablation of the tumour and a multinodular goitre with a cold isthmic nodule which raised the possibility of the diagnosis of Carney's complex.

[Acute relapsing pericarditis induced by screw-in atrial pacing lead. Apropos of 3 cases]. / Péricardite aiguë è rechutes induite par une électrode atriale vissée. A propos de 3 observations.

Contrary to the ventricle where pacing leads remain passively implanted, the use of active screw-in atrial pacing leads has rapidly developed during the last few years. This type of fixation in a thin and fragile cardiac wall carries a risk of perforation and thereby of pericardial complications. The authors report three original cases of a period of time. The responsibility of the atrial lead was highly probable given the presence of suggestive symptoms (pericardial pain) or of pericardial complications confirmed at surgery, of the presence of radiological changes in 2 cases (localised bulges of the cardiac silhouette opposite the site of implantation of the pacing lead), the absence of any other detectable cause and, finally, cure after explantation of the causal pacing lead and anti-inflammatory drug therapy. Some simple preventive measures based on the properties of the material (screw length < 2 mm), the technique of implantation, should help avoid these complications or, at least, to reduce their frequency.