[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.

Intra-thoracic blood volume measurement by contrast magnetic resonance imaging.

The intra-thoracic blood volume (ITBV) is a cardiovascular parameter related to the cardiac preload and left ventricular function. Its assessment is, therefore, important for diagnosis and follow-up of several cardiovascular dysfunctions. Nowadays, the ITBV can be accurately measured only by invasive indicator dilution techniques, which require a double catheterization of the patient. In this study, a novel technique is presented for ITBV assessment by dynamic magnetic resonance imaging after intravenous injection of a small bolus of gadolinium chelate. The dose was chosen on the basis of in vitro calibration. The bolus first pass is detected from a simultaneous dynamic image series of the right and left ventricles. Two indicator dilution curves are derived and used to inspect the transpulmonary dilution system. Various mathematical models for the interpretation of the measured indicator dilution curves are compared. The ITBV is assessed as the product of the transpulmonary mean transit time of the indicator and the cardiac output, obtained by phase contrast magnetic resonance angiography. In vitro measurements showed a correlation coefficient larger than 0.99 and preliminary tests with volunteers proved the feasibility of the method, opening new possibilities for noninvasive quantitative cardiovascular diagnostics.

Understanding of hazardous waste incineration through computational fluid-dynamics simulation.

Rotary kiln incinerators are widely used in the incineration of hazardous wastes of various types. However, the complex transport and chemical processes within the kiln system are still not well understood. The complete destruction of hazardous compounds depends very much on gas mixing behavior of different air and waste streams, the distribution of gas temperature and residence time within the kiln and the secondary combustion chamber (SCC). Due to large variations of waste types and difficulties in feed characterization (physical, chemical and thermal properties), the incineration process meets great challenges in a smooth operation, with substantial fluctuations of gas temperatures within the system. The temperature fluctuations lead to uncertainties in the process chemistry and difficulties in emission control. The newly enforced regulations from the European Union with stricter emission levels require a better understanding of the incineration process and improved process control for lower emissions and a better environmental impact. In order to get better understanding of the incineration process within the rotary kiln system, research was carried out to study the kiln behavior in relation to better process control. One of the focuses was on the process simulation by using Computational Fluid-dynamics (CFD) to characterize gas flow, temperature distribution and waste combustion in the rotary kiln incinerator. Temperature measurement of the operating rotary kiln incinerator at AVR-Chemie, located at the Rotterdam harbor in The Netherlands, was conducted to validate the CFD model and to provide the information to kiln operators at AVR. This paper will address the environmental issues related to the hazardous waste incineration, and summarize the results from the current research project for the simulation of gas flow and mixing, combustion heat transfer, and new ideas to use CFD simulation results for process control of an incineration plant.