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To assess the diagnostic value of the screening instrument SPUTOVAMO-R2 (checklist, 5 questions) for child abuse at Out-of-hours Primary Care locations (OPC), by comparing the test outcome with information from Child Protection Services (CPS). Secondary, to determine whether reducing the length of the checklist compromises diagnostic value. All children (<18 years) attending one of the participating OPCs in the region of Utrecht, the Netherlands, in a year time, were included. The checklist is an obligatory field in the electronic patient file. CPS provided data on all checklist positives and a sample of 5500 checklist negatives (dataset). The checklist outcome was compared with a report to CPS in 10 months follow up after the OPC visit. The checklist was filled in for 50671 children; 108 (0.2%) checklists were positive. Within the dataset, 61 children were reported to CPS, with emotional neglect as the most frequent type of abuse (32.8%). The positive predictive value (PPV) of the checklist for child abuse was 8.3 (95% CI 3.9-15.2). The negative predictive value (NPV) was 99.1 (98.8-99.3), with 52 false negatives. When the length of the checklist was reduced to two questions closely related to the medical process (SPUTOVAMO-R3), the PPV was 9.1 (3.7-17.8) and the NPV 99.1 (98.7-99.3). These two questions are on the injury in relation to the history, and the interaction between child and parents. The checklist SPUTOVAMO-R2 has a low detection rate of child abuse within the OPC setting, and a high false positive rate. Therefore, we recommend to use the shortened checklist only as a tool to increase the awareness of child abuse and not as a diagnostic instrument.

Healing of early-gestation fetal wounds results in scarless healing. Since the capacity for regeneration is probably inherent to the fetal skin itself, knowledge of the fetal skin composition may contribute to the understanding of fetal wound healing. The aim of this study was to analyze the expression profiles of different epidermal and dermal components in the human fetal and adult skin. In the human fetal skin (ranging from 13 to 22 weeks' gestation) and adult skin biopsies, the expression patterns of several epidermal proteins (K10, K14, K16, K17, SKALP, involucrin), basement membrane proteins, Ki-67, blood vessels and extracellular matrix proteins (fibronectin, chondroitin sulfate, elastin) were determined using immunohistochemistry. The expression profiles of K17, involucrin, dermal Ki-67, fibronectin and chondroitin sulfate were higher in the fetal skin than in adult skin. In the fetal skin, elastin was not present in the dermis, but it was found in the adult skin. The expression patterns of basement membrane proteins, blood vessels, K10, K14, K16 and epidermal Ki-67 were similar in human fetal skin and adult skin. In this systematic overview, most of the differences between fetal and adult skin were found at the level of dermal extracellular matrix molecules expression. This study suggests that, especially, dermal components are important in fetal scarless healing.

The objective of this study is to develop and validate a screening instrument for the recognition of child maltreatment in the emergency department (ED). Existing data on screening questions and outcomes (diagnosis of child maltreatment) from three large observational screening studies at eight different EDs in the Netherlands were harmonized. A multivariate logistic regression was performed to develop the Screening instrument for Child Abuse and Neglect (SCAN). The SCAN was validated by performing a cross-validation and calculating the discriminative ability. A total of 24,963 patients were included. Out of the potential screening questions the following questions were included in the final instrument: is the injury compatible with the history, and does it correspond to the child’s developmental level? (aOR 10.40, 95% CI 5.69–19.02), was there an unnecessary delay in seeking medical help? (aOR 3.45, 95% CI 1.73–6.88) and is the behaviour/interaction of the child and parents (carers) appropriate? (aOR 14.67, 95% CI 7.93–27.13). The SCAN had a pooled AUC of 0.75 (95% CI 0.63–0.87) in the cross-validation. The question “Are there other signals that make you doubt the safety of the child and/or family?” (available in only one of the original datasets, OR 182.9; 95% CI 102.3–327.4) was by consensus added to the final SCAN. Conclusion : This validated and brief Screening instrument for Child Abuse and Neglect (SCAN) is designed to improve early recognition of child maltreatment in the ED. A positive screening result of the SCAN warrants a thorough work-up for child maltreatment, including a top-toe examination, if necessary additional diagnostics and adequate safety measures. What is Known: • Screening instruments increase the detection of possible cases of child maltreatment in the emergency department and support health care professionals to identify these cases. • The application of different screening instruments led to the need for one brief validated instrument. What is New: • This study presents a validated and brief Screening instrument for Child Abuse and Neglect (SCAN), consisting of four questions. • The SCAN supports professionals in detecting signals of child maltreatment, and a positive screening result should lead to a thorough work-up, including a top-toe examination, complete history, additional diagnostic tests and consultation of a child abuse expert.

In standing ophthalmic surgery in horses, a retrobulbar nerve block (RNB) is often placed blindly for anesthesia and akinesia. The ultrasound (US)-guided RNB may have fewer complications, but the two techniques have only been compared once in equine cadavers. This study compares the techniques for success and complication rates and analyzes the effect of training on US guidance. Twenty-two equine cadavers were divided into three groups: blind RNBs were performed bilaterally in eight cadavers, US-guided RNBs were performed bilaterally in seven cadavers, and after US-guided training, blind RNBs were performed bilaterally in seven cadavers. All RNBs were performed by the same two inexperienced operators, and a combination of contrast medium (CM; 1.25 mL) and methylene blue dye (1.25 mL) were injected (2.5 mL total volume). Needle positioning in the periorbita and the distance of the CM to the optic foramen were assessed using computerized tomography (CT). Dye spreading was evaluated by dissection. In group 1, 37.5% of the injections were in the optimal central position in the periorbita; in group 2, 75% and in group 3, 71.4%. There was no significant difference between the groups regarding needle position (groups 1 and 2 p = 0.056; groups 1 and 3 p = 0.069, groups 2 and 3 p = 0.8). The mean CM distribution distance was not significantly different between all groups. Group 1 had 18.75% intraocular injections versus 0% in group 2 and 7.1% in group 3 (not significant). US guidance showed no significant increases in accuracy nor decreases in complications. However, the effects on accuracy showed a trend towards significant improvement, and larger scale follow-up studies might show significant training effects on US guidance.

This paper aims to understand the value of collaboration in a ‘state of emergency’ situation, featuring the case of the water, sanitation and hygiene (WASH) sector in Zimbabwe over the period 2008–2012. During this period, a group of stakeholders engaged in a structured collaboration, called the WASH cluster. This initiative was taken to respond to severe and frequent cholera outbreaks. Over these 5 years, the collaborating partners engaged in a voluntary partnership, which attracted attention due to the ascribed improvements of some key health indicators. Drawing from the body of literature on collaboration, the research confirms the applicability of findings on both the process and key features of successful collaboration and was able to position the evolution of the Zimbabwean case in the continuum of collaboration arrangements proposed in the literature. Likewise, the specific sequencing and causality of steps in the creation and development of the Zimbabwean WASH cluster were found to match those of the collaborative pathway. Finally, the findings confirm the general applicability of principles of collaboration, although the evaluation of its outcomes poses challenges. In addition, the research found that inasmuch as prominent leaders enhance collaboration, leadership by permanent government bodies promotes sustainability of the collaborative approach.

1. Effects of climate change may affect the Sphagnum species composition in bogs, and ultimately the functioning of the whole ecosystem. We investigated the effect of different water tables on the competition between six Sphagnum species in the glasshouse. The amount of precipitation (234 mm year⁻¹) and precipitation frequency (every 2 weeks) were kept low to encourage water-table effects. Relevant species combinations and monocultures were grown at different water tables for a 16-month period. We studied changes in cover, height increment and capitulum water content (WCcap) in order to understand competitive responses. 2. Species naturally occurring further above the water table generally showed higher competitive strength than species naturally occurring closer to the water table. Surprisingly, this effect was irrespective of the water table, indicating a minor role for capillary water transport. Cover change seemed to be related to differences in length growth, but not to water table or WCcap. 3. The WCcap of species within a mixture did not differ, but was lower than the WCcap of the individual species growing in monoculture, indicating differences in ability to supply water to the capitula between mono- and mixed cultures. Subcapitulum bulk densities between mono- and mixed cultures did not differ, or were even lower in monocultures, but did differ between species within mixed cultures. 4. Our results indicate that structural heterogeneity of the peat in mixed cultures has a negative effect on WCcap of both species. Furthermore, we show that sustained periods of drought cause species that naturally occur further above the water table to oust species that naturally occur closer to the water table, even if the water table remains high. Ultimately, the Sphagnum vegetation in raised bogs may shift from hollow to hummock species, evening out the natural microtopography of raised bogs.

Background. Child abuse in Suriname has a prevalence between 58.2% and 68.8%. This prospective observational study evaluates the implementation of screening for child abuse at the Emergency Department (ED) of the Academic Hospital Paramaribo (AZP). Methods. Children (0-16 years) presenting with injury from 01-02-2018 until 31-08-2018 were eligible. Case-record-forms were completed. Multidisciplinary meetings were used to evaluate positive screened and admitted patients. Diagnostic accuracy was calculated and results were compared to retrospective data from 2016. Results. 3253 Children attended the ED. In 1190 (36.6%) children, the screening was completed. The screening was positive in 148 (12%); in 71 (6%) cases child abuse was confirmed. The sensitivity and specificity were 0.88 and 0.92 respectively, PPV 0.43, NPV 0.99. There was a significant increase of detected child abuse cases; 4.4% in 2016 versus 6% in 2018 (P = .04). Conclusion. Implementation of screening at the ED in the AZP increased detection of child abuse. To improve screening’s accuracy, more education for healthcare professionals is pivotal.

Background Older cancer patients may search for health information online to prepare for their consultations. However, seeking information online can have negative effects, for instance increased anxiety due to finding incorrect or unclear information. In addition, existing online cancer information is not necessarily adapted to the needs of older patients, even though cancer is a disease often found in older individuals. Objective The aim of this study was to systematically develop, implement and evaluate an online health information tool for older cancer patients, the Patient Navigator, providing information that complements the consultation with healthcare providers. Method For the development and evaluation of the Patient Navigator, the four phases of the MRC framework were used. In the first and second phase the Patient Navigator was developed and pilot tested based on previous research and sub-studies. During the third phase the Patient Navigator was implemented in four Dutch hospitals. In the last phase, a pilot RCT was conducted to evaluate the Patient Navigator in terms of usage (observational tracking data), user experience (self-reported satisfaction, involvement, cognitive load, active control, perceived relevance of the tool), patient participation (observational data during consultation), and patient outcomes related to the consultation (questionnaire data regarding anxiety, satisfaction, and information recall). Recently diagnosed colorectal cancer patients (N = 45) were randomly assigned to the control condition (usual care) or the experimental condition (usual care + Patient Navigator). Results The Patient Navigator was well used and evaluated positively. Patients who received the Patient Navigator contributed less during the consultation by using less words than patients in the control condition and experienced less anxiety two days after the consultation than patients in the control condition. Conclusion Since the Patient Navigator was evaluated positively and decreased anxiety after the consultation, this tool is potentially a valuable addition to the consultation for patients. Usage of the Patient Navigator resulted in patients using less words during consultations, without impairing patients’ satisfaction, possibly because information needs might be fulfilled by usage of the Patient Navigator. This could create the possibility to personalize communication during consultations and respond to other patient needs.

Question: Is it possible to translate vegetation maps into reliable thematic maps of site conditions? Method: This paper presents a new method, called Iteratio, by which a coherent spatial overview of specific environmental conditions can be obtained from a comprehensive vegetation survey of a specific area. Iteratio is a database application which calculates environmental indicator values for vegetation samples (relevés) on the basis of known indicator values of a limited number of plant species. The outcome is then linked to a digitalized vegetation map (map of plant communities) which results in a spatial overview of site conditions. Iteratio requires the indicator values of a minimum of 10-20% of the species occurring. The species are given a relative weight according to their amplitudes: species with a narrow range are weighted stronger, species with a broad range are weighted weaker. Conclusion: The method presented here enables a coherent assessment of site conditions on the basis of a vegetation survey and the indicator values of a limited number of plant species.

The peat and pore-water biogeochemistry of an Irish oceanic raised bog are reported with a view to understanding the origin and development of a minerotrophic soak contained within an ombrotrophic bog. Depth profiles of electrical conductivity, pore-water chemistry and peat chemistry were recorded from the mire surface down to a maximum depth of 10 m (approximately 1 m into the underlying mineral soil) from the centre of Lough Roe, a minerotrophic soak on Clara Bog in the Irish midlands, and from a location in the surrounding bog. Distinct differences in the hydrochemistry and peat chemistry between both sites are evident in the upper 5 m of the profile, indicating that conditions differed during the latter development of the mire, despite both sites being located on the apex of the raised bog dome. As expected, the profiles recorded from the ombrotrophic bog are characterised by low ionic concentrations in the upper bog peat with an increase in the concentration of calcium and other ions in the lower fen peat (from 5.5 m depth). At the Lough Roe site, the profile shows relatively high concentrations of calcium and other ions in the upper part of the profile. To our knowledge, this is the first report of such detailed minerotrophic chemical profiles from the central area of a raised bog dome. We hypothesize that the relevant minerals originate from the underlying clay layer and fen peat within the basin of the bog and the minerals prevailed within the soak because of (1) the generation of a flow of water from the developing bog through the minerotrophic fen peat towards the soak during its early development, and (2) increased rates of decomposition within the soak throughout its existence. The implications for the future conservation management of the site are discussed.