[Multiple sclerosis and bipolar disorder: an overlap between soma and psyche]. / Multiple sclerose en bipolaire stoornis: overlap tussen soma en psyche.

This clinical vignette describes a 29-year-old woman who had her first neurological manifestations of multiple sclerosis (MS) on the same day as a second lifetime manic episode as part of a bipolar I disorder. The patient was stable for eight years before this episode. An MRI-scan conducted during admission showed multiple demyelinating lesions in the frontal cortex, which might have influenced the development and course of the manic episode. Her manic symptoms went into remission during the same time as her neurological symptoms. This clinical vignette with literature review is an illustration of the interesting, yet still unknown relationship between MS and affective disorders, where one might be influenced by the other but also have a common pathophysiology. This highlights that the dividing line between neurology and psychiatry, whose pathophysiology often takes place in the same organ, is often arbitrary.

Nitrogen fertilisers with urease inhibitors reduce nitrous oxide and ammonia losses, while retaining yield in temperate grassland.

Nitrogen fertilisation, although a cornerstone of modern agricultural production, negatively impacts the environment through gaseous losses of nitrous oxide (N2O), a potent greenhouse gas (GHG), and ammonia (NH3), a known air pollutant. The aim of this work was to assess the feasibility of urea treated with urease inhibitors to reduce gaseous N losses in temperate grassland, while maintaining or improving productivity compared to conventional fertiliser formulations. Urease inhibitors were N-(n-butyl)-thiophosphoric triamide (NBPT) (urea + NBPT) and N-(n-propyl)-thiophosphoric triamide (NPPT) (urea+ NBPT + NPPT), while conventional fertilisers were urea and calcium ammonium nitrate (CAN). N2O emission factors were 0.06%, 0.07%, 0.09% and 0.58% from urea + NBPT, urea, urea + NBPT + NPPT and CAN, respectively, with CAN significantly higher than all the urea formulations, which were not significantly different from each other. Ammonia loss measured over one fertiliser application was significantly larger from urea, at 43%, compared with other formulations at 13.9%, 13.8% and 5.2% from urea + NBPT, urea + NBPT + NPPT and CAN, respectively. Changing fertiliser formulation had no significant impact on grass yield or N uptake in four out of five harvests. In the last harvest urea + NBPT significantly out-yielded urea, but not CAN or urea + NBPT + NPPT. Overall, urea treated with either one or both urease inhibitors significantly reduced emissions of N2O and NH3, while preserving yield quantity and quality. Therefore, changing fertiliser formulation to these products should be encouraged as a strategy to reduce GHG and air pollution from agricultural practices in temperate climate.

Scenarios to limit environmental nitrogen losses from dairy expansion.

Increased global demand for dairy produce and the abolition of EU milk quotas have resulted in expansion in dairy production across Europe and particularly in Ireland. Simultaneously, there is increasing pressure to reduce the impact of nitrogen (N) losses to air and groundwater on the environment. In order to develop grassland management strategies for grazing systems that meet environmental targets and are economically sustainable, it is imperative that individual mitigation measures for N efficiency are assessed at farm system level. To this end, we developed an excel-based N flow model simulating an Irish grass-based dairy farm, to evaluate the effect of farm management on N efficiency, N losses, production and economic performance. The model was applied to assess the effect of different strategies to achieve the increased production goals on N utilization, N loss pathways and economic performance at farm level. The three strategies investigated included increased milk production through increased grass production, through increased concentrate feeding and by applying a high profit grass-based system. Additionally, three mitigation measures; low ammonia emission slurry application, the use of urease and nitrification inhibitors and the combination of both were applied to the three strategies. Absolute N emissions were higher for all intensification scenarios (up to 124 kg N ha-1) compared to the baseline (80 kg N ha-1) due to increased animal numbers and higher feed and/or fertiliser inputs. However, some intensification strategies showed the potential to reduce the emissions per ton milk produced for some of the N-loss pathways. The model showed that the assessed mitigation measures can play an important role in ameliorating the increased emissions associated with intensification, but may not be adequate to entirely offset absolute increases. Further improvements in farm N use efficiency and alternatives to mineral fertilisers will be required to decouple production from reactive N emissions.

Feeding dicyandiamide (DCD) to cattle: An effective method to reduce N2O emissions from urine patches in a heavy-textured soil under temperate climatic conditions.

Nitrate (NO3-) leaching and nitrous oxide (N2O) emission from urine patches in grazed pastures are key sources of water and air pollution, respectively. Broadcast spraying of the nitrification inhibitor dicyandiamide (DCD) has been shown to reduce these losses, but it is expensive. As an alternative, it had been demonstrated that feeding DCD to cattle (after manual mixing with supplementary feeds) was a practical, effective and cheaper method to deliver high DCD rates within urine patches. This two-year study carried out on simulated urine patches in three application seasons (spring, summer, autumn) explored the efficacy of DCD feeding to cattle to reduce N losses from grazed pasture soil in a heavy-textured soil under temperate climatic conditions. In each application season, DCD fed to cows, then excreted with urine and applied at a rate of 30kgDCDha-1 (treatment U+DCD30-f) was as effective as powdered DCD mixed with normal urine and applied at the same rate (treatment U+DCD30) at reducing cumulative N2O-N emissions and the N2O-N emission factor (EF3, expressed as % of N applied). Increasing DCD loading within urine patches from 10 to 30kgDCDha-1 improved efficacy by significantly reducing the EF3 from 34% to 64%, which highlights that under local conditions, 10kgDCDha-1 (the recommended rate for commercial use in New Zealand) was not the optimum DCD rate to curb N2O emissions. The modelling of EF3 in this study also suggests that N mitigation should be given more attention when soil moisture is going to be high, which can be predicted with short-term weather forecasting. DCD feeding, for instance in autumn when cows are not lactating and the risk of N losses is high, could then be reduced by focusing mainly on those forecasted wet periods.

Improving and disaggregating N2O emission factors for ruminant excreta on temperate pasture soils.

Cattle excreta deposited on grazed grasslands are a major source of the greenhouse gas (GHG) nitrous oxide (N2O). Currently, many countries use the IPCC default emission factor (EF) of 2% to estimate excreta-derived N2O emissions. However, emissions can vary greatly depending on the type of excreta (dung or urine), soil type and timing of application. Therefore three experiments were conducted to quantify excreta-derived N2O emissions and their associated EFs, and to assess the effect of soil type, season of application and type of excreta on the magnitude of losses. Cattle dung, urine and artificial urine treatments were applied in spring, summer and autumn to three temperate grassland sites with varying soil and weather conditions. Nitrous oxide emissions were measured from the three experiments over 12months to generate annual N2O emission factors. The EFs from urine treated soil was greater (0.30-4.81% for real urine and 0.13-3.82% for synthetic urine) when compared with dung (-0.02-1.48%) treatments. Nitrous oxide emissions were driven by environmental conditions and could be predicted by rainfall and temperature before, and soil moisture deficit after application; highlighting the potential for a decision support tool to reduce N2O emissions by modifying grazing management based on these parameters. Emission factors varied seasonally with the highest EFs in autumn and were also dependent on soil type, with the lowest EFs observed from well-drained and the highest from imperfectly drained soil. The EFs averaged 0.31 and 1.18% for cattle dung and urine, respectively, both of which were considerably lower than the IPCC default value of 2%. These results support both lowering and disaggregating EFs by excreta type.

Reducing nitrous oxide emissions by changing N fertiliser use from calcium ammonium nitrate (CAN) to urea based formulations.

The accelerating use of synthetic nitrogen (N) fertilisers, to meet the world's growing food demand, is the primary driver for increased atmospheric concentrations of nitrous oxide (N2O). The IPCC default emission factor (EF) for N2O from soils is 1% of the N applied, irrespective of its form. However, N2O emissions tend to be higher from nitrate-containing fertilisers e.g. calcium ammonium nitrate (CAN) compared to urea, particularly in regions, which have mild, wet climates and high organic matter soils. Urea can be an inefficient N source due to NH3 volatilisation, but nitrogen stabilisers (urease and nitrification inhibitors) can improve its efficacy. This study evaluated the impact of switching fertiliser formulation from calcium ammonium nitrate (CAN) to urea-based products, as a potential mitigation strategy to reduce N2O emissions at six temperate grassland sites on the island of Ireland. The surface applied formulations included CAN, urea and urea with the urease inhibitor N-(n-butyl) thiophosphoric triamide (NBPT) and/or the nitrification inhibitor dicyandiamide (DCD). Results showed that N2O emissions were significantly affected by fertiliser formulation, soil type and climatic conditions. The direct N2O emission factor (EF) from CAN averaged 1.49% overall sites, but was highly variable, ranging from 0.58% to 3.81. Amending urea with NBPT, to reduce ammonia volatilisation, resulted in an average EF of 0.40% (ranging from 0.21 to 0.69%)-compared to an average EF of 0.25% for urea (ranging from 0.1 to 0.49%), with both fertilisers significantly lower and less variable than CAN. Cumulative N2O emissions from urea amended with both NBPT and DCD were not significantly different from background levels. Switching from CAN to stabilised urea formulations was found to be an effective strategy to reduce N2O emissions, particularly in wet, temperate grassland.

The effect of renovation of long-term temperate grassland on N2O emissions and N leaching from contrasting soils.

Renovation of long-term grassland is associated with a peak in soil organic N mineralisation which, coupled with diminished plant N uptake can lead to large gaseous and leaching N losses. This study reports on the effect of ploughing and subsequent N fertilisation on the N2O emissions and DON/NO3(-) leaching, and evaluates the impact of ploughing technique on the magnitude and profile of N losses. This study was carried out on isolated grassland lysimeters of three Irish soils representing contrasting drainage properties (well-drained Clonakilty, moderately-drained Elton and poorly-drained Rathangan). Lysimeters were manually ploughed simulating conventional (CT) and minimum tillage (MT) as two treatments. Renovation of grassland increased N2O flux to a maximum of 0.9kgN2O-Nha(-1) from poorly-drained soil over four days after treatment. Although there was no difference between CT and MT in the post-ploughing period, the treatment influenced subsequent N2O after fertiliser applications. Fertilisation remained the major driver of N losses therefore reducing fertilisation rate post-planting to account for N mineralised through grassland renovation could reduce the losses in medium to longer term. Leaching was a significant loss pathway, with the cumulative drainage volume and N leached highly influenced by soil type. Overall, the total N losses (N2O+N leached) were lowest from poorly and moderately draining soil and highest for the well draining soil, reflecting the dominance of leaching on total N losses and the paramount importance of soil properties.

Techno-economic analysis of CHP system supplied by waste forest biomass.

Poland, as for Europe, is a country with an average forest cover of approximately 30%. In these forests, more than 37M m3 of wood, mostly coniferous (over 80%), is harvested per year. In 2012, 4.2M m3 of sawn timber was produced (sawn timber without factory lumber). At the same time, in Poland there are over 8000 sawmills, whereas only about 700 of them saw over 90% of the harvested timber. So much fragmentation is a major cause of low sawmills innovation, particularly of those small ones. However, in recent years, a trend of development in this sector is noticeable, and it is through rationalisation of material and energy economy. One of the methods to increase the technical and economic effectiveness of enterprises involved in woodworking is to build in the combined heat and power system (CHP) plant with the ORC system into the existing infrastructure, which will be matched to the needs of the company. This article presents an analysis of the profitability of the investment based on the example of a medium-sized company sawing approximately 50,000 m3 of timber per year, and the economic analysis was performed for prices and costs valid in Poland. The analysis made for the 1650 kW(el) organic Rankine cycle (ORC) system, has resulted in a profitability index PI = 1.3, on the assumptions that the ORC system operates for 6000 h y(-1), will be purchased at the price of 4500 € kW(el)(-1) and at the price of electricity sales of 130 € MWh(-1).

In situ N2O emissions are not mitigated by hippuric and benzoic acids under denitrifying conditions.

Ruminant urine patches deposited onto pasture are a significant source of greenhouse gas nitrous oxide (N2O) from livestock agriculture. Increasing food demand is predicted to lead to a rise in ruminant numbers globally, which, in turn will result in elevated levels of urine-derived N2O. Therefore mitigation strategies are urgently needed. Urine contains hippuric acid and together with one of its breakdown products, benzoic acid, has previously been linked to mitigating N2O emissions from urine patches in laboratory studies. However, the sole field study to date found no effect of hippuric and benzoic acid concentration on N2O emissions. Therefore the aim of this study was to investigate the in situ effect of these urine constituents on N2O emissions under conditions conducive to denitrification losses. Unadulterated bovine urine (0 mM of hippuric acid, U) was applied, as well as urine amended with either benzoic acid (96 mM, U+BA) or varying rates of hippuric acid (8 and 82 mM, U+HA1, U+HA2). Soil inorganic nitrogen (N) and N2O fluxes were monitored over a 66 day period. Urine application resulted in elevated N2O flux for 44 days. The largest N2O fluxes accounting for between 13% (U) and 26% (U+HA1) of total loss were observed on the day of urine application. Between 0.9 and 1.3% of urine-N was lost as N2O. Cumulative N2O loss from the control was 0.3 kg N2O-Nha(-1) compared with 11, 9, 12, and 10 kg N2O-Nha(-1) for the U, U+HA1, U+HA2, and U+BA treatments, respectively. Incremental increases in urine HA or increase in BA concentrations had no effect on N2O emissions. Although simulation of dietary manipulation to reduce N2O emissions through altering individual urine constituents appears to have no effect, there may be other manipulations such as reducing N content or inclusion of synthetic inhibitory products that warrant further investigation.

[Mission statements of Dutch mental health institutions; the quality of communication with stakeholders]. / Mission statements van Nederlandse ggz-instellingen; de kwaliteit van communicatie met belanghebbenden.

BACKGROUND: As a result of recent reforms in Dutch health care, healthcare providers are having to operate more and more like commercial organisations and adopt some of the rules prevailing in the profit sector. Because missions statements can be an efficient means of useful communication with internal and external stakeholders they can make a useful contribution to the way healthcare institutions are managed and to their status and reputation. Research shows that in view of this the quality of the messages conveyed via mission statements is important. AIM: To ascertain which stakeholders are mentioned in the mission statements of Dutch mental healthcare providers and to quantify the quality of the messages conveyed to them via mission statements. METHOD: We examined the mission statements of 34 mental health providers to find out which stakeholders were included. The message conveyed to the stakeholders was quantified by means of a validated measuring instrument devised specifically for this purpose. RESULTS: Patients were referred to in all mission statements and the quality of the messages conveyed was of higher quality than the messages conveyed to other stakeholders. Other important stakeholders on whom the institutions depended were referred to much less frequently and the quality of sections of text referring to them was definitely inferior. CONCLUSION: Mission statements frequently serve as management tool for Dutch mental healthcare providers. The potential benefits that these statements could bestow on the providers are not being fully exploited because the standard of communication with several internal and external stakeholders is of poor quality.

Early childhood caries in Indigenous communities: A joint statement with the American Academy of Pediatrics.

The oral health of Indigenous children of Canada (First Nations, Inuit and Métis) and the United States (American Indian and Alaska Native) is a major child health issue. This is exemplified by the high prevalence of early childhood caries (ECC) with resulting adverse health effects, as well as high rates and costs of restorative and surgical treatments under general anesthesia. ECC is an infectious disease that is influenced by multiple factors, including socioeconomic determinants, and requires a combination of approaches for improvement. The present statement includes recommendations for oral health preventive and clinical care for young infants and pregnant women by primary health care providers, community-based health promotion initiatives, oral health workforce and access issues, and advocacy for community water fluoridation and fluoride varnish program access. Further community-based research on the epidemiology, prevention, management and microbiology of ECC in Indigenous communities would be beneficial.

Raman analysis of caraway (Carum carvi L.) single fruits. Evaluation of essential oil content and its composition.

FT-Raman spectroscopy was applied for in situ analysis of single and intact fruits obtained from a diverse caraway (Carum carvi L.) collection. The Raman spectra showed characteristic bands that could be assigned to lignin, unsaturated fatty acids, and polysaccharides. Additionally, the essential oil composition was determined by gas chromatography (GC), which showed a great variation in carvone and limonene content among accessions obtained from European botanical gardens as well as advanced breeding materials. GC data and information obtained from Raman measurements were correlated and allowed development of calibration models for essential oil yield and carvone and limonene content (R(2) = 74%, 81%, and 75%, respectively). The congruence between results obtained by both techniques indicates FT-Raman spectroscopy to be a valuable screening tool for quality control and selection of fruits with desired essential oil composition, which can be performed without fruit destruction.

[Sexsomnia during treatment with a selective serotonin reuptake inhibitor]. / Sekssomnia tijdens behandeling met een selectieve serotonineheropnameremmer.

Sexsomnia is a parasomnia characterised by sexual behaviour. A 30-year-old man, with no history of parasomnias or related precipitating factors, developed sexual behaviour during sleep after three weeks of treatment with escitalopram 10 mg daily. The parasomnia disappeared on the sixth day after the escitalopram had been stopped. The temporal relationship between the use of this selective serotonin reuptake inhibitor and the occurrence of the parasomnia suggests a causal relationship, possibly related to increased serotonergic neurotransmission in the raphe nucleus.

[Unipolar depression suddenly switches to hypomania in a patient who has just started taking venlafaxine]. / Acute stemmingsomslag naar hypomanie bij een patiënte met een unipolaire depressie direct na starten van venlafaxine.

A woman with a recurrent episode of a depression that hitherto had been unipolar developed a hypomania the day after her treatment with paroxetine 20 mg/day was switched to venlafaxine 75 mg/day. The hypomanic symptoms subsided gradually as the dosage was reduced and the patient thereafter remained in a euthymic state while on venlafaxine at a dose of 18.75 mg/day. Three possible explanations are discussed for the patient's response: there was a pharmacokinetic interaction between paroxetine and venlafaxine, the patient had an idiosyncratic reaction to venlafaxine or venlafaxine inhibited the re-uptake of norepinephrin.

Title VII funding is associated with more family physicians and more physicians serving the underserved.

Title VII funding of departments of family medicine at U.S. medical schools is significantly associated with expansion of the primary care physician workforce and increased accessibility to physicians for the residents of rural and underserved areas. Title VII has been successful in achieving its stated goals and has had an important role in addressing U.S. physician workforce policy issues.

Structural changes in fused silica after exposure to focused femtosecond laser pulses.

Using in situ Raman scattering in a confocal microscopy setup, we have observed changes in the network structure of fused silica after modifying regions inside the glass with tightly focused 800-nm 130-fs laser pulses at fluences of 5-200 J cm(-2). The Raman spectra show a large increase in the peaks at 490 and 605cm(-1), owing to 4- and 3-membered ring structures in the silica network, indicating that densification occurs after exposure to the femtosecond laser pulses. The results are consistent with the formation of a localized plasma by the laser pulse and a subsequent microexplosion inside the glass.

4.0-4.5-mum lasing of Fe:ZnSe below 180 K, a new mid-infrared laser material.

Lasing of Fe:ZnSe is demonstrated, for the first time to the authors' knowledge, for temperatures ranging from 15 to 180 K. The output wavelength of the Fe:ZnSe laser was observed to tune with temperature from 3.98mum at 15 K to 4.54mum at 180 K. With an Er:YAG laser operating at 2.698mum as the pump source, a maximum energy per pulse of 12muJ at 130 K was produced. Laser slope efficiencies of 3.2% at 19 K and 8.2% at 150 K were determined for an output coupling of 0.6%. A laser emission linewidth of 0.007mum at 3.98mum was measured at 15 K. Absorption and emission spectra and emission lifetimes for Fe:ZnSe are also discussed.

Factors influencing the career choices of physicians trained at Yale-New Haven Hospital from 1929 through 1994.

PURPOSE: To examine factors that influenced, positively or negatively, the specialty career choices of physicians trained at Yale-New Haven Hospital (YNHH) from 1929 to 1994. METHOD: The authors sent questionnaires to 4,888 physicians who had trained or were training in YNHH-sponsored residency programs. The physicians rated 36 factors posited to be influenced in career choice on a seven-point Likert scale from very negative to very positive. The authors compared the means of each factor's ratings by decade of medical school graduation. RESULTS: The most positively rated influences were similar in each decade from the 1920s to the 1990s. These influences shared characteristics of intellectual curiosity ("intellectual content of the specialty" and "challenging diagnostic problems"), altruism ("interest in helping people" and "opportunity to make differences in people's lives"), and personal identity ("consistent with personality" and "possess the required skill or ability"). Negative factors, such as "demands on time and effort," "stress in the field," and "malpractice costs," were also consistently rated throughout the decades. CONCLUSION: The reasons that physicians choose certain specialty careers have not changed significantly over the past 65 years despite all the changes that have occurred in medicine. Physicians continue to seek professional opportunities that are viewed as intellectually challenging and of benefit to others.