Non-uniformity in pre-insertional Achilles tendon is not influenced by changing knee angle during isometric contractions.

Achilles tendinopathy remains a prevalent condition among recreational and high-level athletes. Mechanical loading has become the gold standard in managing these injuries, but exercises are often generic and prescribed in a "one-size-fits-all" principle. The aim of this study was to evaluate the impact of knee angle changes and different levels of force production on the non-uniform behavior in the Achilles tendon during isometric contractions. It was hypothesized that a flexed knee position would lead to a more distinct non-uniform behavior, due to greater differential loading of soleus vs gastrocnemius, and that this effect would be attenuated by higher levels of force production. Contrary to the hypotheses, it was found that the non-uniform deformation, that is, superficial-to-deep variation in displacement with highest displacement in the deep layer, is consistently present, irrespective of the level of force production and knee angle (n = 19; mean normalized displacement ratio 6.32%, 4.88%, and 4.09% with extended knee vs 5.47%, 2.56%, and 6.01% with flexed knee, at 25%, 50%, and 75% MVC, respectively; P > .05). From tendon perspective, aside from the influence on muscle behavior, this might question the mechanical rationale for a change in knee angle during eccentric heel drops. Additionally, despite reaching high levels of plantar flexion force, the relative contribution of the AT sometimes appears to be decreased, potentially due to compensatory actions by agonist muscle groups. These results are relevant for optimizing AT rehabilitation as the goal is to reach specific local tendon loading.

[Predicting short term intramural violence with the Instrument for Forensic Treatment Evaluation (IBFE), ROM-instrument in tbs for different target groups]. / Voorspellen van intramuraal geweld op korte termijn met het Instrument voor Forensische Behandelevaluatie (IFBE), ROM-instrument in de tbs voor verschillende doelgroepen.

BACKGROUND: The Instrument for Forensic Treatment Evaluation (IFTE) has proven to be useful as an instrument for treatment evaluation and risk management in a heterogeneous group of tbs-patients (tbs = court ordered psychiatric treatment for offenders with a mental disorder). However, it is not known whether this ROM-instrument is a predictor of short term inpatient violence in different tbs-groups.
AIM: To investigate the extent to which the factor Problematic behavior of the IFBE is useful for predicting intramural violence, taking the different target groups in tbs into account. To demonstrate the practical value of the ifte factor Problematic behavior for inpatient violence risk management.
METHOD: Using logistic regression, the predictive validity of the ifte-factor Problematic behavior for inpatient violence was established in a 4 to 8-month follow-up, taking the different target groups into account. Cut-off points based on ROC analysis determined whether this factor could be of practical value for risk management.
RESULTS: The factor Problematic behavior predicted inpatient violence, irrespective of the target group, with an odds ratio of 1.68. A cut-off score of 7, on a scale of 1 to 17, correctly assessed 82% of the patients as a high or low risk for inpatient violent behavior.
CONCLUSION: The factor Problematic behavior of the IFBE can contribute to the prediction of short term inpatient violence for different tbs patient groups.

[Abolition of the internment of convicted prisoners in Belgium: clinical implications]. / Klinische implicaties van afschaffing van de ministeriële internering in België: onderzoek naar profiel van Vlaamse geïnterneerden-veroordeelden.

BACKGROUND: According to article 21 of the current Belgian law regarding the protection of society, the ministry of Justice can transfer a convicted prisoner to the Commission for the Protection of Society if that prisoner develops a severe mental illness in the course of a prison sentence. The proposed abolition of this article is raising concerns in psychiatric hospitals which are not equipped to deal with dangerous forensic patients.
AIM: To explore the profiles of convicted internees and to find out to what extent they differ from the profiles of regular internees.
METHOD: Convicted internees (n = 48) and regular internees (n = 483) treated in one of the Flemish medium security units were compared on the basis of demographic, clinical and risk factors.
RESULTS: Compared to regular internees, convicted internees suffered from more serious psychiatric problems and showed a more severe risk profile.
CONCLUSION: The abolition of article 21 presents regular psychiatric hospitals with new challenges.

[Clinical decision making with regard to the granting of escorted leave for forensic patients detained by court order in a Dutch psychiatric clinic. Role of gender, disorder and the type of offence in the procedure]. / Behandelduur tot eerste toekenning tbs-verlof in een Nederlandse forensische psychiatrische kliniek; dossieronderzoek naar invloed van patiëntkenmerken en delict.

BACKGROUND: An increase in the length of time until the first escorted leave is granted to a patient detained by court order (tbs) results in a longer period of treatment. Physicians involved in the treatment and clinic managers are striving to reduce, in a responsible manner, the length of the period of treatment preceding the patient's first escorted leave.
AIM: Forensic Psychiatric Clinic (fpk) 'De Woenselse Poort' aims to find out to what extent gender, pathology and the type of offence committed by the detainee influence the length of time that elapses before the patient's first leave is granted. METHOD: We conducted a retrospective study based on patients' records. RESULTS: Although men use physical aggression more often than women, we found that gender, pathology and the type of offence had no influence on the length of the treatment period that preceded the granting of the patient's first escorted leave. CONCLUSION: Partly on the basis of risk management scales, clinicians judge whether the patient has adopted a more positive or a more negative attitude to risk factors relating to his or her offence. If the risk factors have become more positive, one would expect the application for leave to be made earlier. Surprisingly, this was not the case. In order to speed up the decision-making process regarding the application for leave, a clinical method for evaluating risk related treatment needs to be developed in which offence related risk factors are identified and the patient's positive or negative attitude to these risks are measured and monitored. At each treatment evaluation practitioners should be required to produce arguments that determine whether or not the patient is to be granted permission to go on leave at a particular moment.

[Treatment evaluation and clinical decision making using HKT-30-ROM]. / Behandelevaluatie en klinische besluitvorming met HKT-30-ROM.

BACKGROUND: By means of repeated, well-supported measurements of clinical dynamic indicators from the Historical, Clinical and Future - 30 (HKT-30) it is possible to monitor behavioural changes on the basis of risks and needs. The addition of extra score parameters allows us to distinguish client-specific risks and needs. In treatment evaluation it is important to visualise changes in these indicators of treatment evaluation because they are the key to the clinical decision-making process that determines further treatment and rehabilitation. AIM: To investigate whether HKT-30 indicators can be used to measure and visualise behavioral changes for the purpose of treatment evaluation. METHOD: A case study is used to illustrate how clinicians at the Forensic Psychiatric Clinic (FPK), De Woenselse Poort, ascertain risks, needs and changes and clarify these factors for the purpose of treatment evaluation and clinical decision-making. RESULTS: Routine treatment evaluation aided by visualised clinical HKT-30 indicators give the treatment team and the client a clearer picture of the behavioral changes for which the forensic treatment was prescribed. This evaluation provides significant starting-points for clinical decision making. CONCLUSION: Routine treatment evaluation along with a suitably adjusted HKT-30 make behavioural changes visible, render clinical decisions more transparent and provide valuable starting-points for a dialogue with the client about his treatment.

Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance.

OBJECTIVE: Developing good interpersonal relationships is one of the main impediments for people with an antisocial personality disorder (ASPD). However, in treatment of psychiatric disorders, establishing a strong therapeutic alliance (TA) is important for effective treatment. Nevertheless, there is little knowledge on how to establish this TA with this challenging patient group. This study investigates which factors are important in TA development. METHOD: For this study, a qualitative research methodology is applied. In-depth interviews with therapists experienced in treating ASPD were conducted and analysed through thematic analysis. RESULTS: The analysis revealed six themes important in alliance formation: the patient's needs, regulating interpersonal dynamics, connective attitude, connective skills, treatment process and treatment goals. Each theme is defined including aspects of the recommended therapeutic attitude and required skills for therapists working with patients with ASPD. CONCLUSIONS: This study determined that, for therapists working with patients with ASPD, several key factors are essential in establishing a strong TA. These factors include the ability to be firm, authentic, non-judgmental and genuinely involved. An attentive presence is crucial, in which the therapist takes initiative in establishing contact and makes the patient feel that he is truly seen as an autonomous and equal person. In doing so, the therapist needs to provide clarity and structure while remaining perceptive to boundary violations. The therapist must be able to set limits using a clear yet kind tone of voice. Furthermore, it was notable that an intensive appeal is made to the therapist's reflective capacity in these treatments.

Sarcopenia in end-stage liver disease and after liver transplantation.

Sarcopenia occurs in 30-70% of patients with end-stage liver disease and is associated with inferior pre- and post-liver transplant outcomes such as prolonged intubation times, long intensive care and hospitalization times, heightened risk of post-transplant infection, reduced health-related quality of life, and increased rates of mortality. The pathogenesis of sarcopenia is multifactorial and involves biochemical disturbances such as hyperammonemia, low serum concentrations of branched-chain amino acids (BCAAs) and low serum levels of testosterone, as well as chronic inflammation, inadequate nutritional status, and physical inactivity. Prompt recognition and accurate assessment of sarcopenia are critical and require imaging, dynamometry, and physical performance testing for the assessment of its subcomponents: muscle mass, muscle strength, and muscle function, respectively. Liver transplantation mostly fails to reverse sarcopenia in sarcopenic patients. In fact, some patients develop de novo sarcopenia after undergoing liver transplantation. The recommended treatment of sarcopenia is multimodal and includes a combination of exercise therapy and complementary nutritional interventions. Additionally, new pharmacological agents (e.g. myostatin inhibitors, testosterone supplements, and ammonia-lowering therapy) are under investigation in preclinical studies. Here, we present a narrative review of the definition, assessment, and management of sarcopenia in patients with end-stage liver disease prior to and after liver transplantation.

Experiencing discrimination mediates the relationship between victimization and social withdrawal in patients suffering from a severe mental illness: A cross-sectional study.

Psychiatric patients are often victims of crime and discrimination and are often socially withdrawn. This has negative consequences for their health and recovery. We examined whether such discrimination mediates the association between victimization and social withdrawal, and whether these associations differ between men and women. We also determined the prevalence of social withdrawal and the discrimination experienced by patients suffering from a severe mental illness. This study is embedded in the Victimization in Psychiatric Patients study. Information on discrimination, social withdrawal and victimization was obtained using structured self-report questionnaires (N = 949). We reported the 12-month prevalence of these phenomena and used path analysis to estimate the direct path between personal and property victimization and social withdrawal, and the indirect path through the discrimination experienced. The impact of gender was assessed by testing interaction terms. Social withdrawal was reported by 20.6% (95%CI 18.1-23.2) of participants, and being discriminated against in the past 12 months by 75.3% (95%CI: 72.6-78.0%). While crime victimization had no direct effects on social withdrawal, personal crime victimization (B = 0.47; 95%CI 0.25-0.72; p < 0.001) and property crime victimization (B = 0.65; 95%CI 0.42-0.93; p < 0.001) had significant indirect effects on social withdrawal, which were mediated by the discrimination experienced. In men we found a direct negative effect of property crime on social withdrawal (B = -0.68; 95%CI: -1.21to -0.11, p = 0.014). We conclude that personal and property victimization, for both men and women, was associated with higher levels of social withdrawal, and this was fully mediated by the discrimination experienced.

Type D personality and posttraumatic stress disorder in victims of violence: a cross-sectional exploration.

The current study explored the relationship between type D personality and posttraumatic stress disorder (PTSD) among victims of violence (n = 189). The basic premise underlying the type D concept is that it is not the experience of negative emotions per se that renders individuals at risk of maladjustment in the face of adversity, but the way they are dealt with. Particularly the combination of high negative affectivity and social inhibition (i.e., the non-expression of emotions and inhibition of behaviours in social interactions) is assumed to be maladaptive. It was hypothesized that a high score on negative affectivity (i.e., above a pre-determined cut-off score) would only contribute to PTSD in the presence of a high score on social inhibition (also above a pre-determined cut-off score). Univariate results indicated that type D subjects (type Ds) reported higher PTSD symptom levels than those characterized by high negative affectivity/low social inhibition or low negative affectivity. Type Ds more often suffered from probable PTSD than non-type Ds. In multivariate analyses, type D personality was associated with an increased risk of probable PTSD above and beyond background variables, while high negative affectivity/low social inhibition was not. Results were discussed in light of victim support practices and study limitations.

Grandiose and vulnerable narcissism, identity integration and self-control related to criminal behavior.

BACKGROUND: Although systematic research on narcissism has been conducted for over 100 years, researchers have only recently started to distinguish between grandiose and vulnerable narcissism in relation to criminal behavior. In addition, there is some evidence suggesting that identity integration and self-control may underlie this association. Therefore, the present study aimed to develop a theory-driven hypothetical model that investigates the complex associations between grandiose and vulnerable narcissism, identity integration, self-control, and criminal behavior using structural equation modeling (SEM). METHODS: The total sample (N = 222) included 65 (29.3%) individuals convicted of criminal behavior and 157 (70.7%) participants from the community, with a mean age of 37.71 years (SD = 13.25). Criminal behavior was a grouping variable used as a categorical outcome, whereas self-report questionnaires were used to assess grandiose and vulnerable narcissism, self-control, and identity integration. RESULTS: The overall SEM model yielded good fit indices. Grandiose narcissism negatively predicted criminal behavior above and beyond the influence of identity integration and self-control. In contrast, vulnerable narcissism did not have a direct significant effect on criminal behavior, but it was indirectly and positively associated with criminal behavior via identity integration and self-control. Moreover, grandiose narcissism was positively, whereas vulnerable narcissism was negatively associated with identity integration. However, identity integration did not have a direct significant effect on criminal behavior, but it was indirectly and negatively associated with criminal behavior via self-control. Finally, self-control was, in turn, negatively related to criminal behavior. CONCLUSIONS: We propose that both subtypes of narcissism should be carefully considered in clinical assessment and current intervention practices.

Theta/SMR Neurofeedback Training Works Well for Some Forensic Psychiatric Patients, But Not for Others: A Sham-Controlled Clinical Case Series.

Electroencephalographic (EEG) neurofeedback could be a promising treatment for forensic psychiatric patients. Increasing evidence shows some patients are unable to regulate cortical activity. Before neurofeedback can be applied successfully, research is needed to investigate the interpersonal mechanisms responsible for patients' ability to respond to neurofeedback. A single-case experimental design allows for close monitoring of individual patients, providing valuable information about patients' response to the intervention and the time frame in which changes in clinical symptoms can be observed. Four patients with Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; DSM-IV-TR) substance use disorder and various comorbidities participated in a sham-controlled clinical case study. Self-report level of impulsivity and craving were assessed. Results indicate that one patient showed more improvements on behavioral measures after the neurofeedback training than did the others. This patient reported less impulsivity and reduced levels of self-reported craving. However, these findings could not be attributed to the neurofeedback intervention. The findings suggest that there is insufficient evidence for the beneficial effects of a theta/sensorimotor rhythm (SMR) neurofeedback intervention on measures of impulsivity and craving, and that there may be great interindividual differences in patients' ability to regulate cortical activity.

Social support, attachment and externalizing behavior in forensic patients with attention-deficit hyperactivity disorder.

This study was designed to provide more insight into the relationship between social support and externalizing behavior in forensic patients with ADHD. Because ADHD is highly associated with psychosocial impairment, we expected poor social support and attachment insecurity (i.e., preoccupied, fearful, and dismissive attachment) to be associated with higher levels of externalizing behaviors in forensic patients with ADHD. Self-reports of 32 forensic male outpatients with ADHD (M age = 35.34) were compared with self-reports of healthy (n = 32; M age = 33.84), and 'at risk' control males with (a history of) psychological problems (n = 30; M age = 36.47) from the general population. In addition, associations between social support, attachment and externalizing behaviors (i.e., aggression, antisociality, anger and hostility) were examined within the sample as a whole. Analyses of variance showed that forensic patients with ADHD had higher levels of externalizing behaviors and insecure attachment, and lower levels of secure attachment compared to both healthy and at risk controls. Multivariate regression analyses showed that social support was not associated with any of the externalizing behaviors, after accounting for attachment. In contrast, insecure attachment was associated with higher levels of all externalizing behaviors examined. Finally, insecure attachment best explained antisociality and hostility, suggesting that attachment is more important than other psychopathological risk factors that distinguish the different groups.

Aneurysmal bone cyst of the nose with 17p13 involvement.

We report on a 6-year-old girl with a polypoid mass, filling up the entire right nasal cavity as shown on a magnetic resonance imaging scan. Histologically, the tumor had the characteristics of an aneurysmal bone cyst, which is extremely rare in this location. Cytogenetic analysis disclosed a single (6:17)(p21;p13) translocation, confirming a specific genetic involvement in the development of aneurysmal bone cysts. Fluorescent in situ hybridization analysis mapped the putative gene between the p53 (17p13.1) and the Mieller-Dieker gene (17p13.3) loci.

Posttraumatic anger, recalled peritraumatic emotions, and PTSD in victims of violent crime.

A mixed cross-sectional and longitudinal design was employed to explore the association between posttraumatic anger and posttraumatic stress disorder (PTSD; symptoms) in victims of civilian violence. It was speculated that this relationship is mainly due to concurrent recalled peritraumatic emotions. Such emotions may be interpreted to result from anger-rooted threat perceptions and to share similarities with posttraumatic intrusion symptoms. In addition, predictors of PTSD maintenance were investigated. Cross-sectional data indicated that posttraumatic anger and several indices of PTSD were highly interconnected. Recalled peritraumatic emotions partly accounted for the relation between posttraumatic anger and posttraumatic intrusions (n = 177). Only posttraumatic intrusions were associated with PTSD symptom persistence at follow-up (n = 56). Findings were discussed in light of study limitations and directions for future research.

Intra- and extra-familial child molestation as pathways building on parental and relational deficits and personality disorders.

This article addresses the intra- and extra-familial pathways of child molestation. The data presented show preliminary evidence that the difference between the intra- and extra-familial routes can be explained by schizoid and avoidant (intra-familial) and antisocial and passive-aggressive (extra-familial) personality structures. This study also reveals that the amount of warmth and autonomy received during childhood is associated with both intra- and extra-familial child-molesting behaviour. These findings contribute to a further explanation of this deviant sexual conduct and to the development and differentiation of the treatment of child molesters.

Income Attainment among Victims of Violence: Results From a Preliminary Study.

Violent victimisation may have many short-term psychological and physical outcomes. Occasionally, the negative aftermath of violence persists over time or induces other and more far-reaching consequences. Income attainment after victimisation is one of these outcomes. To date, previous studies have focussed on the income effects of violent victimisation during childhood and adolescence. Violence exposure during the early stages of the life course may frustrate processes of educational and occupational attainment and consequentially result in lower income levels. However, in addition or alternatively, many other and age-independent pathways between violent victimisation and income may be suggested. Prior studies appear to have paid little attention to this issue. Therefore, the purpose of the current study was to explore whether violent victimisation is associated with income levels several years after victimisation, irrespective of the age at which victimisation occurs. Victims of violence were recruited through the Dutch Victim Compensation Fund. To preliminary estimate the effect of violent victimisation on income, a comparable control group of non-victims was composed. The study sample contained 206 victims and 173 non-victims. Both bivariate correlational and multivariate statistical techniques suggested that violent victimisation is a significant predictor of income. Implications of the presented results were discussed with regard to future research and policy practice.

cAMP inhibits bud growth in a yeast strain compromised for Ca2+ influx into the Golgi.

Biochemical and physiological studies have implicated cAMP and cAMP-dependent protein kinase (PKA) in a plethora of essential cellular processes. Here we show that yeast cells partially depleted of PKA activity (due to a tpkw mutation) and bearing a lesion in a Golgi-localized Ca2+ pump (Pmr1), arrest division with a small bud. The bud morphology of the arrested tpk1w pmr1 mutant cells is characteristic of cells in S phase; however, the terminal phenotype of processes such as DNA replication and nuclear division suggests arrest at the G2/M boundary. This small bud, G2-arrest phenotype is similar to that of strains with a defect in cell wall biosynthesis (pkc1) or membrane biogenesis (och1); however, the biochemical defect may be different since the tpk1w pmr1 double mutants retain viability. The growth defect of the tpk1w pmr1 mutant can be alleviated by preventing the increase in cellular cAMP levels that is known to be associated with a decrease in PKA activity, or by supplementing the medium with millimolar amounts of Ca2+. Although the biochemical consequences of this increase in cAMP concentration are not known, the small-bud phenotype of the double mutant and the known protein processing defect of the pmr1 lesion suggest that the localization or function of some membrane component might be compromised and susceptible to perturbations in cellular cAMP levels. One candidate for such a protein is the cAMP-binding membrane ectoprotein recently described in yeast.

[Attempt to elaborate an explanating model of adolescents' contraceptive behavior]. / Essai d'elaboration d'un modele explicatif du comportement contraceptif des adolescentes.

PIP: Of the 3 main currents of literature seeking to explain adolescent pregnancy, the medical and demographic currents have essentially produced descriptions of behaviors, attitudes, and opinions, while the psychological current has produced primarily hypotheses interpreting sexual and contraceptive behavior in terms of predispositions. This work seeks to develop an explanatory framework for adolescent sexual and contraceptive behavior in which situational variables would be included. The explanatory variables utilized in the framework were informative and sociological variables, beliefs associated with side effects of contraceptive methods, social support for contraceptive use, norms associated with heterosexual behavior, ability to foresee future consequences, future prospects, perceptions of pregnancy and its consequences, and evaluation of the risk of pregnancy. A semiclosed questionnaire exploring the different model variables was orally administered to 186 female secondary school students in Liege, France. The data were subjected to a discriminant function analysis which permitted assessment of the role of each explanatory variable in determining contraceptive behavior. 53% of the respondents did not use contraception. 91% of those using contraception used pills. 5 types of contraceptive behavior were noted: 1) 20% of the sample were sexually active and had always used contraception 2) 20% were sexually active and used contraception but had not always done so 3) 13% were sexually active but had never used contraception 4) 40% were not sexually active and did not use contraception, and 5) 7% were not sexually active but used a contraceptive. The variables explained 75% of the difference between adolescents who used and did not use contraception, and 39% of the difference between adolescents ever exposed to risk of pregnancy or never exposed. The principle variables explaining use or nonuse of contraception were stated in declining order of importance. Girls having sexual relations under 17 years of age were much less likely to use a contraceptive method. 3 dimensions of norms associated with sexual behavior were relevant: adolescents using contraception had a more positive attitude toward sex, were less affected by aversion to programming or planning sexual activity, and had a more flexible sexual morality. Adolescents using contraception had parents and other associates who were more likely to approve of pill use, and they had less fear of the side effects of pills. Adolescents not using contraception tended to be under 17, with rigid norms associated with sexual behavior, weak social support for pill use, and beliefs in the negative effects of pills. Sexually active adolescents not using contraception tended to come from larger families, to have more unfavorable views of condoms than other adolescents, to have less social support for use of condoms than other adolescents, to want to have a child within the next 2 years, and to come from the lower social classes.^ieng