The workshop “How companies improve critical raw materials criticality” was co-organized by the International Round Table on Materials Criticality in its current project IRTC-Business. After IRTC... Show moreThe workshop “How companies improve critical raw materials criticality” was co-organized by the International Round Table on Materials Criticality in its current project IRTC-Business. After IRTC had investigated the potential of circular strategy to mitigate criticality of critical raw materials in earlier events, discussions and publications, the workshop aimed at understanding concrete applications of circular strategies, in order to identify their drivers and hurdles. For this, a variety of companies were invited to present their business models. Show less
Diermen, L. van; Poljac, E.; Mast, R. van der; Plasmans, K.; Ameele, S. van den; Heijnen, W.; ... ; Kamperman, A. 2021
Objective: Several clinical variables assumed to be predictive of electroconvulsive therapy (ECT) outcome in major depressive disorder show substantial interrelations. The current study tries to... Show moreObjective: Several clinical variables assumed to be predictive of electroconvulsive therapy (ECT) outcome in major depressive disorder show substantial interrelations. The current study tries to disentangle this interdependence to distill the most important predictors of treatment success to help improve patient-treatment matching.Methods: We constructed a conceptual framework of interdependence capturing age, episode duration, and treatment resistance, all variables associated with ECT outcome, and the clinical symptoms of what we coin core depression, ie, depression with psychomotor agitation, retardation, psychotic features, or a combination of the three. The model was validated in a sample of 73 patients with a major depressive episode according to DSM-5 treated twice weekly with ECT (August 2015-January 2018) using path analyses, with the size and direction of all direct and indirect paths being estimated using structural equation modeling. Reduction in Montgomery-Asberg Depression Rating Scale (MADRS) scores during treatment was the ECT outcome measure.Results: The baseline presence of psychomotor agitation, retardation, and/or psychotic symptoms strongly correlated with beneficial ECT outcome (z = 0.84 [SE = 0.17]; P < .001), and the association between age and the effect of ECT appears to be mediated by their presence (z = 0.53 [SE = 0.18]; P = .004). There was no direct correlation between age and ECT response (P = .479), but there was for episode duration and ECT outcome (z = -0.38 [SE = 0.08]; P < .001).Conclusions: ECT is a very effective treatment option for severe depressive disorder, especially for patients suffering from severe depression characterized by the presence of psychomotor agitation, psychomotor retardation, psychotic symptoms, or a combination of these 3 features, with the chance of a beneficial outcome being reduced in patients with a longer episode duration. Age may heretofore have been given too much weight in ECT decision making. Show less
Hebbrecht, K.; Giltay, E.J.; Birkenhager, T.K.; Sabbe, B.; Verwijk, E.; Obbels, J.; ... ; Diermen, L. van 2020
Objective The Montreal Cognitive Assessment (MoCA) is a sensitive and clinically practical test but its usefulness in measuring long-term cognitive effects of ECT is unclear. Using the MoCA, we... Show moreObjective The Montreal Cognitive Assessment (MoCA) is a sensitive and clinically practical test but its usefulness in measuring long-term cognitive effects of ECT is unclear. Using the MoCA, we investigated short- and long-term global cognitive change in ECT-treated patients with a Major Depressive Episode (MDE). Method We included 65 consecutive ECT-treated patients with MDE, in whom global cognitive functioning was assessed at baseline (T0); during ECT (before the third session; T1); and 1 week (T2), 3 months (T3), and 6 months (T4) after completion of the index course. Changes in MoCA (sub)scores were analyzed using linear mixed models and reliable change indices were computed to investigate individual changes in MoCA total scores. Results There was a significant effect of time on MoCA scores (F(4, 230.5) = 4.14,P = 0.003), with an improvement in global cognitive functioning from T3 compared to T1 and T2. At the individual level, 26% (n = 17) of patients showed a significantly worse cognitive functioning at T2 and 12% (n = 8) an improved cognitive functioning compared to T0. For T4, these percentages ameliorated to 8% and 18% respectively. Conclusion No persistent global cognitive impairment induced by ECT was found at the group level using the MoCA. At the individual level, however, there was clear heterogeneity in the effects of ECT on cognitive functioning. The MoCA is a suitable tool to monitor short- and long-term global cognitive functioning in ECT-treated patients with MDE but in younger patients, potential ceiling effects must be taken into account. Show less
Purpose Assessing impacts of abiotic resource use has been a topic of persistent debate among life cycle impact assessment (LCIA) method developers and a source of confusion for life cycle... Show morePurpose Assessing impacts of abiotic resource use has been a topic of persistent debate among life cycle impact assessment (LCIA) method developers and a source of confusion for life cycle assessment (LCA) practitioners considering the different interpretations of the safeguard subject for mineral resources and the resulting variety of LCIA methods to choose from. Based on the review and assessment of 27 existing LCIA methods, accomplished in the first part of this paper series (Sonderegger et al. 2020), this paper provides recommendations regarding the application-dependent use of existing methods and areas for future method development. Method Within the "global guidance for LCIA indicators and methods" project of the Life Cycle Initiative hosted by UN Environment, 62 members of the "task force mineral resources" representing different stakeholders discussed the strengths and limitations of existing LCIA methods and developed initial conclusions. These were used by a subgroup of eight members at the Pellston Workshop (R) held in Valencia, Spain, to derive recommendations on the application-dependent use and future development of impact assessment methods. Results and discussion First, the safeguard subject for mineral resources within the area of protection (AoP) natural resources was defined. Subsequently, seven key questions regarding the consequences of mineral resource use were formulated, grouped into "inside-out" related questions (i.e., current resource use leading to changes in opportunities for future users to use resources) and "outside-in" related questions (i.e., potential restrictions of resource availability for current resource users). Existing LCIA methods were assigned to these questions, and seven methods (ADP(ultimate reserves), SOPURR, LIME2(endpoint), CEENE, ADP(economic reserves), ESSENZ, and GeoPolRisk) are recommended for use in current LCA studies at different levels of recommendation. All 27 identified LCIA methods were tested on an LCA case study of an electric vehicle, and yielded divergent results due to their modeling of impact mechanisms that address different questions related to mineral resource use. Besides method-specific recommendations, we recommend that all methods increase the number of minerals covered, regularly update their characterization factors, and consider the inclusion of secondary resources and anthropogenic stocks. Furthermore, the concept of dissipative resource use should be defined and integrated in future method developments. Conclusion In an international consensus-finding process, the current challenges of assessing impacts of resource use in LCA have been addressed by defining the safeguard subject for mineral resources, formulating key questions related to this safeguard subject, recommending existing LCIA methods in relation to these questions, and highlighting areas for future method development. Show less
Purpose The safeguard subject of the Area of Protection "natural Resources," particularly regarding mineral resources, has long been debated. Consequently, a variety of life cycle impact assessment... Show morePurpose The safeguard subject of the Area of Protection "natural Resources," particularly regarding mineral resources, has long been debated. Consequently, a variety of life cycle impact assessment methods based on different concepts are available. The Life Cycle Initiative, hosted by the UN Environment, established an expert task force on "Mineral Resources" to review existing methods (this article) and provide guidance for application-dependent use of the methods and recommendations for further methodological development (Berger et al. in Int J Life Cycle Assess, 2020). Methods Starting in 2017, the task force developed a white paper, which served as its main input to a SETAC Pellston Workshop (R) in June 2018, in which a sub-group of the task force members developed recommendations for assessing impacts of mineral resource use in LCA. This article, based mainly on the white paper and pre-workshop discussions, presents a thorough review of 27 different life cycle impact assessment methods for mineral resource use in the "natural resources" area of protection. The methods are categorized according to their basic impact mechanisms, described and compared, and assessed against a comprehensive set of criteria. Results and discussion Four method categories have been identified and their underlying concepts are described based on existing literature: depletion methods, future efforts methods, thermodynamic accounting methods, and supply risk methods. While we consider depletion and future efforts methods more "traditional" life cycle impact assessment methods, thermodynamic accounting and supply risk methods are rather providing complementary information. Within each method category, differences between methods are discussed in detail, which allows for further sub-categorization and better understanding of what the methods actually assess. Conclusions We provide a thorough review of existing life cycle impact assessment methods addressing impacts of mineral resource use, covering a broad overview of basic impact mechanisms to a detailed discussion of method-specific modeling. This supports a better understanding of what the methods actually assess and highlights their strengths and limitations. Building on these insights, Berger et al. (Int J Life Cycle Assess, 2020) provide recommendations for application-dependent use of the methods, along with recommendations for further methodological development. Show less
Bailey, G.P.; Joyce, J.; Schrijvers, D.; Schulze, R.K.; Sylvestre, A.M.; Sprecher, B.S.; ... ; Acker, K. van 2020
Objectives The presence of psychotic symptoms is an important predictor of responsiveness to electroconvulsive therapy (ECT). This study investigates whether a continuous severity measure, the... Show moreObjectives The presence of psychotic symptoms is an important predictor of responsiveness to electroconvulsive therapy (ECT). This study investigates whether a continuous severity measure, the Psychotic Depression Assessment Scale (PDAS), is a more accurate predictor. Methods Depression severity was assessed before and after the ECT course using the Montgomery-Asberg Depression Rating Scale (MADRS) in 31 patients with psychotic depression and 34 depressed patients without psychotic symptoms. Logistic regression models for MADRS response and remission were fitted, with either the PDAS total score or the dichotomous predictors "absence/presence of psychotic symptoms" as the independent variables. Age, episode duration, and treatment resistance were added as covariates. Results Both the asserted presence of psychotic symptoms and a higher PDAS total score reflected MADRS response (areas under the curve, 0.83 and 0.85, respectively), with MADRS remission also being predicted by the presence of psychotic symptoms and higher PDAS scores (areas under the curves, 0.86 and 0.84, respectively). Age was a contributor to these prediction models, with response and remission rates being highest in the older patients. Psychotic Depression Assessment Scale scores decreased significantly during ECT: at end point, 81.5% of the patients showed significant response and 63.9% had achieved remission. Conclusions The PDAS indeed accurately predicts response to and remission after ECT in (psychotic) depression and most pronouncedly so in older patients but seems to have no clear advantage over simply verifying the presence of psychotic symptoms. This could be the consequence of a ceiling effect, as ECT was extremely effective in patients with psychotic depression. ClinicalTrials.gov: Identifier: NCT02562846. Show less
Diermen, L. van; Vanmarcke, S.; Walther, S.; Moens, H.; Veltman, E.; Fransen, E.; ... ; Schrijvers, D. 2019
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the... Show morePsychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE >= 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment. Show less
