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Longitudinal clinical and functional outcome in distinct cognitive subgroups of first-episode psychosis: a cluster analysis
- Priscilla P. Oomen, Marieke J. H. Begemann, Bodyl A. Brand, Lieuwe de Haan, Wim Veling, Sanne Koops, Jim van Os, Filip Smit, P. Roberto Bakker, Nico van Beveren, Nynke Boonstra, Sinan Gülöksüz, Martijn Kikkert, Joran Lokkerbol, Machteld Marcelis, Bram-Sieben Rosema, Franciska de Beer, Shiral S. Gangadin, Chris N. W. Geraets, Erna van ‘t Hag, Yudith Haveman, Inge van der Heijden, Alban E. Voppel, Elske Willemse, Therese van Amelsvoort, Maarten Bak, Albert Batalla, Agaath Been, Marinte van den Bosch, Truus van den Brink, Gunnar Faber, Koen P. Grootens, Martin de Jonge, Rikus Knegtering, Jörg Kurkamp, Amrita Mahabir, Gerdina H. M. Pijnenborg, Tonnie Staring, Natalie Veen, Selene Veerman, Sybren Wiersma, Ellen Graveland, Joelle Hoornaar, Iris E. C. Sommer
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- Journal:
- Psychological Medicine / Volume 53 / Issue 6 / April 2023
- Published online by Cambridge University Press:
- 19 October 2021, pp. 2317-2327
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Background
Cognitive deficits may be characteristic for only a subgroup of first-episode psychosis (FEP) and the link with clinical and functional outcomes is less profound than previously thought. This study aimed to identify cognitive subgroups in a large sample of FEP using a clustering approach with healthy controls as a reference group, subsequently linking cognitive subgroups to clinical and functional outcomes.
Methods204 FEP patients were included. Hierarchical cluster analysis was performed using baseline brief assessment of cognition in schizophrenia (BACS). Cognitive subgroups were compared to 40 controls and linked to longitudinal clinical and functional outcomes (PANSS, GAF, self-reported WHODAS 2.0) up to 12-month follow-up.
ResultsThree distinct cognitive clusters emerged: relative to controls, we found one cluster with preserved cognition (n = 76), one moderately impaired cluster (n = 74) and one severely impaired cluster (n = 54). Patients with severely impaired cognition had more severe clinical symptoms at baseline, 6- and 12-month follow-up as compared to patients with preserved cognition. General functioning (GAF) in the severely impaired cluster was significantly lower than in those with preserved cognition at baseline and showed trend-level effects at 6- and 12-month follow-up. No significant differences in self-reported functional outcome (WHODAS 2.0) were present.
ConclusionsCurrent results demonstrate the existence of three distinct cognitive subgroups, corresponding with clinical outcome at baseline, 6- and 12-month follow-up. Importantly, the cognitively preserved subgroup was larger than the severely impaired group. Early identification of discrete cognitive profiles can offer valuable information about the clinical outcome but may not be relevant in predicting self-reported functional outcomes.
First assessment of the pore water composition of Rupel Clay in the Netherlands and the characterisation of its reactive solids
- Thilo Behrends, Iris van der Veen, Alwina Hoving, Jasper Griffioen
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- Journal:
- Netherlands Journal of Geosciences / Volume 95 / Issue 3 / September 2016
- Published online by Cambridge University Press:
- 15 July 2016, pp. 315-335
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The Rupel Clay member in the Netherlands largely corresponds to the Boom Formation in Belgium, and this marine, clay-rich deposit is a potential candidate to host radioactive waste disposal facilities. Prediction of the speciation of radionuclides in Rupel Clay pore water and their retardation by interactions with Rupel Clay components requires knowledge about the composition of Rupel Clay pore water, the inventory of reactive solids and understanding of interactions between Rupel Clay and pore water. Here, we studied Rupel Clay material which was obtained from cores collected in the province of Zeeland, the Netherlands, and from drilling cuttings retrieved from a drilling in the province of Limburg, the Netherlands. Pore water was obtained by mechanical squeezing of Rupel Clay material from Zeeland. Additionally, anaerobic dilution experiments were performed in which the clay material was suspended with demineralised water or a 0.1M NaHCO3 solution. Solid-phase characterisation included determination of carbon, nitrogen and sulphur contents, measurement of cation exchange capacity (CEC) and sequential extraction of iron phases.
In contrast to the pore water in Belgian Boom Clay, pore water collected from the location in Zeeland has a higher salinity, with chloride concentrations corresponding to 70–96% of those in seawater. The high chloride concentrations most likely result from the intrusion of ions from saline waters above the Rupel Clay in Zeeland. Cation exchange during salinisation might account for the observed deficit of marine cations (Na, K, Mg) and excess of Ca concentrations, in comparison with seawater. The measured CEC values at both locations in the Netherlands vary between 7 and 35 meq(100g)−1 and are, for most samples, in the range reported for Boom Clay in Belgium (7–30meq(100g)−1).
Pore water and solid-phase composition indicate that Rupel Clay from Zeeland has been affected by oxidation of pyrite or other Fe(II)-containing solids. When coupled to the dissolution of calcium carbonates, oxidation of pyrite can account for the elevated sulphate and calcium concentrations measured in some of the pore waters. The relatively low concentrations of pyrite, organic carbon and calcite in the Rupel Clay in Zeeland, in comparison to Limburg, might be an indicator for an oxidation event. Higher contents of dithionite-extractable Fe in Rupel Clay in Zeeland (0.7–2.6mg Fe / g clay) than in Limburg (0.4–0.5mg Fe / g clay) might also be a consequence of the oxidation of Fe(II) minerals. Oxidation in the past could have accompanied partial erosion of Rupel Clay in Zeeland before deposition of the Breda Formation. However, indications are given that oxidation occurred in some of the pore waters after sampling and that partial oxidation of the cores during storage cannot be excluded. Results from dilution experiments substantiate the influence of equilibration with calcium carbonates on pore water composition. Furthermore, removal of dissolved sulphate upon interaction with Rupel Clay has been observed in some dilution experiments, possibly involving microbial sulphate reduction.