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Once trusted, automated vehicles (AVs) will gradually appear in urban areas. Such a transition is an opportunity in transport planning to control undesired impacts and possibly mitigate congestion at a time when both conventional vehicles (CVs) and AVs coexist. This paper deals with the complex transport decision problem of designing part of the network that is exclusive for AVs through a nonlinear programming model. The objective function minimises the costs of travel times where vehicles circulate under user equilibrium. The model evaluates the benefits of having an AVs-dedicated infrastructure and the associated costs from the detouring of CVs. Three planning strategies are explored: incremental, long-term and hybrid planning. The first creates a subnetwork evolving incrementally over time. The second reversely designs a subnetwork from the optimal solution obtained at a ratio of 90% AVs. The third limits the incremental planning towards that optimal long-term solution. The model is applied to the city of Delft, in the Netherlands. Two scenarios are analysed, with and without AV-dedicated roads, at several AV penetration rates. We find that implementing dedicated roads for AVs reduces the overall costs and congestion up to 16%. However, CV detouring is inevitable at later network stages, increasing the total distance travelled (up to 8%) and congestion in the surroundings of AV subnetworks. Concerning the planning strategies, incremental planning is appropriate for starting in the initial stages and is the strategy that most tackles CV detouring. The hybrid or the long-term strategies are more suitable to be applied after a ratio of 50% AVs, and the hybrid planning is the strategy that most reduces delay. [ABSTRACT FROM AUTHOR]

Background: In the Netherlands, all women aged 30–60 years are invited to participate in the national cervical cancer screening programme, which is aimed at early detection and treatment of precancerous lesions. One fourth of the Dutch population has a migration background, with Turkish and Moroccan immigrants being the largest immigrant populations. Turkish‐ and Moroccan‐Dutch women show lower screening participation rates and a higher incidence of cervical cancer, compared to native Dutch women. Since current information materials are not tailored to these women's needs, we developed a short culturally sensitive educational video to facilitate informed decision‐making for cervical cancer screening among Turkish‐ and Moroccan‐Dutch women. This article describes the development process of this video and the lessons learned. Methods: Using the Entertainment–Education communication strategy, we collaborated with an interdisciplinary team of Turkish‐ and Moroccan‐Dutch women, researchers, public health experts, and creative media professionals. We developed the video following the different stages of the Media Mapping model: Orientation, Crystallization, Design/Production, Implementation, and Dissemination. Each stage is described in the paper. Results: The video was developed in Moroccan‐Arabic, ‐Berber and Turkish, and emphasized three main themes: (1) more certainty about having cervical (pre)cancer and the possibility to prevent treatment, surgery, or premature death, and because of this, being there for the children, (2) according to the Islam, a woman should take good care of her health, and (3) anxiety, shame, and privacy. Conclusions: A short culturally sensitive educational video, delivered as part of a larger intervention together with the current information brochure, was developed based on theory and grounded in the needs of Turkish‐ and Moroccan‐Dutch women. The value and effectiveness of this intervention to facilitate informed cervical cancer screening decisions are evaluated in a randomised controlled trial. Patient or Public Contribution: We collaborated with Turkish‐ and Moroccan‐Dutch women during the development process of a short culturally sensitive educational video. Turkish‐ and Moroccan‐Dutch women were also invited to watch the raw footage to verify whether the content and presentation matched their needs and requirements. [ABSTRACT FROM AUTHOR]

Background & Aims: Cancer is one of the great human challenges in all countries, both advanced and developing. Cancer treatment management can include surgery, chemotherapy, or radiation therapy (1). Radiation therapy is done in two ways: Teletherapy and Brachytherapy. Brachytherapy involves the use of radiation sources to treat cancer by irradiating cancerous tissue from within the patient’s body (2). But the dose and how to use this method has always been questionable for researchers. Therefore, this study creates a new fuzzy approach to high-dose brachytherapy by optimizing the distribution of double roughness based on dosimetric criteria. The use of fuzzy logic itself has increased the accuracy of the mathematical model of the problem. This fuzzy model is a new study and innovation used in this paper. Due to the fuzzy nature of this method and its limitations, it is considered fuzzy. This makes the method more accurate and includes parameters such as the patient’s physical ability and age in the problem, which in itself increases the accuracy of the method for each patient. As a result, the obtained answer is improved and the executive program of brachytherapy method is more accurate. Methods: In the present study, the dose prescribed for an organ was evaluated by dosimetric indices listed in Table 1 (18). For the present study, data from 20 patients in the age range of 50 to 74 and mean age 62 years with a wide range of prostate volume between 23 and 103 cubic centimeters, and for the treatment of prostate cancer by brachytherapy from the Academic Medical Center (AMC, Amsterdam, the Netherlands) had participated. To compare brachytherapy programs with high interstitial dose, the dose rate was calculated with 192Ir beam with a radiation dose of 13 Gy, according to the standard protocol TG-43. To begin with, computed tomography (CT) scans or magnetic resonance imaging (MRI) were taken from the patients pelvis, and entered into the treatment planning software for use in treatment planning sessions. BT treatment planners and specialists then determined the input catheters, target volumes, and OARs obtained from the medical images. Depending on the size and exact location of the target volumes, between 14 and 20 catheters entered the patient’s body, reaching the target volumes. After designing and approving an acceptable treatment plan, the catheters inserted into the patient’s body were connected to a retractor 4 that controls the movement of the radiation source. After the treatment program, the source was returned to the retractor (8, 14). Then, an integer program model with fuzzy constraints was proposed for programming on high-dose brachytherapy. The description of infrastructures, parameters and variables in this model are in Table 2 (15 ). Finally, the dosimeter index is equal to the sum of all the index variables, as it turned out: The proposed model is a correct programming model called IP. In general, three evolutionary algorithms (EP), (GA) and (ES) were used in this research. The algorithms stopped after creating 20 generations of desirable answers and the best answer of each generation was determined on the chart as a point. The resulting set of answers were connected in the form of graphs, which are used to analyze the results. Each point on the graph identifies the best answer from each of the generations generated by the respective algorithms. These three algorithms were performed independently for each patient and the obtained answers were identified as dots on the chart. The graph obtained for each patient indicates the capability of each of these algorithms. Results: According to this study, each of the three algorithms (EP), (GA) and (ES) are each run independently for each of the patients with prostate cancer. At first, the genetic algorithm showed the ability to get closer to the desired answer sooner, but as the optimization process continues, the rate of convergence to the desired answer decreases, so if the time parameter is very important, the genetic algorithm can be useful. Especially for patients whose prostate volume was larger than other patients. In patients 15, 12, 8 and 9, due to their younger age than other patients and better physical condition, as well as prostate volume less than 80 ml, they had much more promising results than other patients. In contrast, for patients 4 and 19 with an age of over 70, the results were not as favorable as for other patients. The * sign in the table indicates that there is no answer through that patient-specific algorithm that covers 95 or even more of the tumor volume. Therefore, according to Table 2, it can be concluded that the best algorithm that can be considered for the case where the shortest time to reach the target coverage above 95% is the genetic algorithm. According to Table 2, it can be concluded that the best algorithm that can be considered for the case where the shortest time to reach the target coverage above 95% is the genetic algorithm. Therefore, according to Table 3, the ES algorithm has better answers than the other two algorithms for the case in which the largest volume of the tumor is covered. According to the results, the ES algorithm has obtained the best results for patients under 60 years of age and normal prostate volume. Conclusion: According to the obtained results, it can be stated that whether the main goal is the maximum coverage or the goal is the shortest possible time to reach the coverage above 95%, the best algorithm that can get a good answer for each patient is the evolutionary strategy algorithm. [ABSTRACT FROM AUTHOR]

Community engagement (CE) has long been endorsed by policy makers and health practitioners. However, uncertainties remain about the workings and outcomes of CE. This study aims to provide in-depth insights into them. In a multiple case study, we investigated three participatory health promotion projects for families in vulnerable situations in the Netherlands. We adopted a realist approach combined with a theory of change (ToC) model. We then analysed the qualitative data for context–mechanism–outcome (CMO) configurations to refine this ToC. Results show that CE can strengthen social networks, empower families, and increase perceived health. However, specific contexts in combination with CE project approaches may or may not trigger positive responses. Participants may feel that they matter when asked to actively contribute to a project, which in turn can enhance their self-confidence. In another context, we found that families were overwhelmed by the responsibilities given to them in the project, leading to feelings of stress and withdrawal from the project. We present a list of CMO configurations and refine the ToC accordingly. Our main conclusion is that flexibility is key when CE is implemented in health promotion. Also, our findings question physical health outcomes as a realistic ambition for CE projects with groups in vulnerable situations. [ABSTRACT FROM AUTHOR]

Background: End-of-life (EoL) care volunteers in hospitals are a novel approach to support patients and their close ones. The iLIVE Volunteer Study supported hospital volunteer coordinators from five European countries to design and implement an EoL care volunteer service on general wards in their hospitals. This study aimed to identify and explore barriers and facilitators to the implementation of EoL care volunteer services in the five hospitals. Methods: Volunteer coordinators (VCs) from the Netherlands (NL), Norway (NO), Slovenia (SI), Spain (ES) and United Kingdom (UK) participated in a focus group interview and subsequent in-depth one-to-one interviews. A theory-inspired framework based on the five domains of the Consolidated Framework for Implementation Research (CFIR) was used for data collection and analysis. Results from the focus group were depicted in radar charts per hospital. Results: Barriers across all hospitals were the COVID-19 pandemic delaying the implementation process, and the lack of recognition of the added value of EoL care volunteers by hospital staff. Site-specific barriers were struggles with promoting the service in a highly structured setting with many stakeholders (NL), negative views among nurses on hospital volunteering (NL, NO), a lack of support from healthcare professionals and the management (SI, ES), and uncertainty about their role in implementation among VCs (ES). Site-specific facilitators were training of volunteers (NO, SI, NL), involving volunteers in promoting the service (NO), and education and awareness for healthcare professionals about the role and boundaries of volunteers (UK). Conclusion: Establishing a comprehensive EoL care volunteer service for patients in non-specialist palliative care wards involves multiple considerations including training, creating awareness and ensuring management support. Implementation requires involvement of stakeholders in a way that enables medical EoL care and volunteering to co-exist. Further research is needed to explore how trust and equal partnerships between volunteers and professional staff can be built and sustained. Trial registration: NCT04678310. Registered 21/12/2020. [ABSTRACT FROM AUTHOR]

Purpose: The investigation goal is the analysis of the relation between healthcare expenditures and other resources, and COVID-19 fatality rates among European countries to design effective health policies for crisis management. Design/methodology/approach: Research methodology is based on descriptive statistics and various parametric methods, also including a linear model of regression to analyze basic relationships of variables under study. Findings: Results show that a lower COVID-19 fatality rate is associated with higher levels of health expenditure (% GDP), of healthcare expenditure per capita, health expenditure in preventive care (% GDP), hospitals per million inhabitants, physicians, nurses, hospital beds and curative acute care beds per 1,000 inhabitants. Regression analysis shows that a 1% increase in healthcare expenditures per capita of countries, it reduces the level of COVID-19 fatality rate by 0.74%. In fact, many countries in Eastern Europe with low healthcare expenditures per capita in 2019 (e.g., Bulgaria, Romania, Hungary, Poland, Latvia, Slovakia, Lithuania, etc.), they have experienced high COVID-19 fatality rates. Instead, a lot of countries in Western Europe, with high healthcare expenditures per capita, such as Germany, Denmark, Austria, and the Netherlands, they had resilient health systems to face pandemic crisis and lower COVID-19 fatality rates. Practical implications: These findings suggest strategies of systematic and continuous investments in healthcare, medical technologies, and ICT infrastructures to support effective health policy of crisis management in countries to face future pandemic crisis and other emergencies in society. Originality/value: The explanation of critical role of high health expenditure (% GDP) and healthcare expenditure per capita to support robust health systems that bolster the resilience in nations to face health emergencies and worldwide crises. [ABSTRACT FROM AUTHOR]

The article focuses on examining how the financialization and marketization of healthcare infrastructures, specifically through the case of Slotervaart Hospital in Amsterdam, Netherlands, contributed to its bankruptcy and left it unprepared for a pandemic. Topics discussed include the intersection of Social Reproduction Theory and financialization, the impact of financialization on healthcare provision, and the shift towards market efficiency in healthcare management.

Empathy has been highlighted as a key concept in chaplaincy care, but its meaning has hardly been explored in depth within this field. This study aims to help develop stronger conceptual clarity by investigating humanist chaplains' conceptualizations of empathy. Data were collected through semi-structured interviews with twenty humanist chaplains working in health care, military, and prisons. A qualitative design was employed to clarify which components and features constitute empathy in humanist chaplaincy care. Empathy emerges as a multidimensional concept that is "fundamentally human." Chaplains distinguish between true and pseudo empathy based on different features including authenticity and concern. This article provides a conceptual model that combines the different components and features of empathy in humanist chaplaincy care and the relationship between them in light of empathy's humanizing quality. It may be used for educational purposes and could function as a conceptual framework for future research efforts. [ABSTRACT FROM AUTHOR]

Background: There is growing evidence to support the benefits of transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement (SAVR) in patients with symptomatic severe aortic stenosis (sSAS) who are at high- or intermediate-risk of surgical mortality. The PARTNER 3 trial showed clinical benefits with SAPIEN 3 TAVI compared with SAVR in patients at low risk of surgical mortality. Whether TAVI is also cost-effective compared with SAVR for low-risk patients in the Dutch healthcare system remains uncertain. This article presents an analysis using PARTNER 3 outcomes and costs data from the Netherlands to inform a cost-utility model and examine cost implications of TAVI over SAVR in a Dutch low-risk population. Methods: A two-stage cost-utility analysis was performed using a published and validated health economic model based on adverse events with both TAVI and SAVR interventions from a published randomized low risk trial dataset, and a Markov model that captured lifetime healthcare costs and patient outcomes post-intervention. The model was adapted using Netherlands-specific cost data to assess the cost-effectiveness of TAVI and SAVR. Uncertainty was addressed using deterministic and probabilistic sensitivity analyses. Results: TAVI generated 0.89 additional quality-adjusted life years (QALYs) at a €4742 increase in costs per patient compared with SAVR over a lifetime time horizon, representing an incremental cost-effectiveness ratio (ICER) of €5346 per QALY gained. Sensitivity analyses confirm robust results, with TAVI remaining cost-effective across several sensitivity analyses. Conclusions: Based on the model results, compared with SAVR, TAVI with SAPIEN 3 appears cost-effective for the treatment of Dutch patients with sSAS who are at low risk of surgical mortality. Qualitative data suggest broader societal benefits are likely and these findings could be used to optimize appropriate intervention selection for this patient population. [ABSTRACT FROM AUTHOR]

We empirically test an integral model for healthcare and child support benefits take-up using a probability sample of the Dutch population (N = 905). To examine how different psychological factors, in conjunction, explain take-up, we apply model averaging with Akaike's Information Criterion (AICC). For both types of benefits, people's perceptions of eligibility best explain take-up. For healthcare benefits, take-up also relates to perceptions of need. Exploratory analyses suggest that for healthcare benefits but not for child support benefits, executive functions, self-efficacy, fear of reclaims, financial stress, and welfare stigma explain perceived eligibility. We find no support for knowledge, support, and administrative burden as explanatory factors in take-up. We discuss the results in relation to the Capability Opportunity Motivation Behaviour (COM-B) model for developing behavioural change interventions. [ABSTRACT FROM AUTHOR]

Social work professionals in urban contexts struggle to serve different groups equally. Critical social work literature advocates critical reflexivity in social work practices. Focusing on existing support practices, it encourages scrutinising the implicit ways social work practices can maintain and reproduce power imbalances and othering structures. However, it has not examined the tensions connected with phases in which the first contact between clients and professionals occurs and clients' engagement in social work programmes begins. Stimulated by an empirical research into parenting-support in a city in the Netherlands, this article examines theoretically the notion of 'encounter practices' through which professionals reach out to people considered in need of support but not asking for help. We disentangle how encounter practices can be interpreted through different understandings of professional engagement, emerging from either critical or affirmative traditions of social work. The encounter context poses specific challenges for critical reflexivity, but it also offers the possibility of exploring one's social positioning in relation to others through informal micro-interactions preceding the instalment of professional relations between professionals and parents. Drawing on insights from urban studies, we distinguish 'fleeting', 'convivial' and 'engaged encounters' as different levels of encounter that allow unsettling othering structures in outreach practices. [ABSTRACT FROM AUTHOR]

Informal care, meaning taking health-related care of people in their own social network, is a topic that gets more and more attention in social science research because the pressure on people to provide informal care is rising due to ageing societies and policy changes. The Informal Care Model developed by Broese van Groenou and de Boer (Eur J Ageing 13(3):271–279, 2016) provides a theoretical foundation to understand under what conditions a person provides informal care. We test this theoretical model by applying it to intrapersonal changes in informal care provision during the first COVID-19 lockdown in the Netherlands in Spring 2020. Data from the LISS panel from two time points, March 2020 and data from July over the period of April/May 2020, were analysed with multinominal multilevel regression analysis (N = 1270 care situations of 1014 caregivers). Our results showed that the individual determinants (Do I have to?, Do I want to?, and especially Can I?) discussed in the Informal Care Model (apart from a series of control variables) are contributing substantially to the understanding of intrapersonal changes in care provision during the first lockdown and by that, we found empirical support for the theoretical model. We conclude that on top of its original purpose to explain between-individual differences in informal caregiving using static indicators, the Informal Care Model is also useful to explain intrapersonal changes in informal caregiving using dynamic indicators. [ABSTRACT FROM AUTHOR]

In the Netherlands, about one‐third of the adult population provides unpaid care. Providing informal caregiving can be very straining in normal times, but the impact of a public health crisis on caregivers is largely unknown. This study focuses on the question of how caregiver burden changed following the COVID‐19 pandemic, and what characteristics were related to these changes. We use self‐reported data from a sample of 965 informal caregivers from the Netherlands 3 months into the pandemic to investigate how the objective burden (i.e. hours spent on caregiving) and the subjective burden had changed, and what their care‐related quality of life (CarerQol) was. We found that on average the subjective burden had increased slightly (from 4.75 to 5.04 on a 0–10 scale). However, our analysis revealed that some caregivers were more affected than others. Most affected caregivers were women, and those with low income, better physical health, decreased psychological health, childcare responsibilities, longer duration of caregiving and those caring for someone with decreased physical and psychological health. On average, time spent on care remained the same (a median of 15 h per week), but certain groups of caregivers did experience a change, being those caring for people in an institution and for people with a better psychological health before the pandemic. Furthermore, caregivers experiencing changes in objective burden did not have the same characteristics as those experiencing changes in perceived burden and quality of life. This shows that the consequences of a public health crisis on caregivers cannot be captured by a focus on either objective or subjective burden measures or quality of life alone. Long‐term care policies aiming to support caregivers to persevere during a future crisis should target caregivers at risk of increased subjective burden and a lower CarerQol, such as women, people with a low income and people with childcare responsibilities. Such policies should consider that reducing objective burden may not necessarily lead to a reduction in subjective burden for all caregivers. [ABSTRACT FROM AUTHOR]

Objectives The aim of this study was to identify sex-specific prevalence and strength of risk factors for the incidence of radiographic knee OA (incRKOA). Methods Our study population consisted of 10 958 Rotterdam Study participants free of knee OA in one or both knees at baseline. One thousand and sixty-four participants developed RKOA after a median follow-up time of 9.6 years. We estimated the association between each available risk factor and incRKOA using sex stratified multivariate regression models with generalized estimating equations. Subsequently, we statistically tested sex differences between risk estimates and calculated the population attributable fractions (PAFs) for modifiable risk factors. Results The prevalence of the investigated risk factors was, in general, higher in women compared with men, except that alcohol intake and smoking were higher in men and high BMI showed equal prevalence. We found significantly different risk estimates between men and women: high level of physical activity [relative risk (RR) 1.76 (95% CI: 1.29–2.40)] or a Kellgren and Lawrence score 1 at baseline [RR 5.48 (95% CI: 4.51–6.65)] was higher in men. Among borderline significantly different risk estimates was BMI ≥27, associated with higher risk for incRKOA in women [RR 2.00 (95% CI: 1.74–2.31)]. The PAF for higher BMI was 25.6% in women and 19.3% in men. Conclusion We found sex-specific differences in both presence and relative risk of several risk factors for incRKOA. Especially BMI, a modifiable risk factor, impacts women more strongly than men. These risk factors can be used in the development of personalized prevention strategies and in building sex-specific prediction tools to identify high risk profile patients. [ABSTRACT FROM AUTHOR]

Objectives: Pre-exposure prophylaxis (PrEP) users are routinely tested four times a year (3 monthly) for asymptomatic Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infections on three anatomical locations. Given the high costs of this testing to the PrEP programme, we assessed the impact of 3 monthly screening(current practice), compared with 6 monthly on the disease burden. We quantified the difference in impact of these two testing frequencies on the prevalence of CT and NG among all men who have sex with men (MSM) who are at risk of an STI, and explored the cost-effectiveness of 3-monthly screening compared with a baseline scenario of 6-monthly screening.Methods: A dynamic infection model was developed to simulate the transmission of CT and NG among sexually active MSM (6500 MSM on PrEP and 29 531 MSM not on PrEP), and the impact of two different test frequencies over a 10-year period. The difference in number of averted infections was used to calculate incremental costs and quality-adjusted life-years (QALY) as well as an incremental cost-effectiveness ratio (ICER) from a societal perspective.Results: Compared with 6-monthly screening, 3-monthly screening of PrEP users for CT and NG cost an additional €46.8 million over a period of 10 years. Both screening frequencies would significantly reduce the prevalence of CT and NG, but 3-monthly screening would avert and extra ~18 250 CT and NG infections compared with 6-monthly screening, resulting in a gain of ~81 QALYs. The corresponding ICER was ~€430 000 per QALY gained, which exceeded the cost-effectiveness threshold of €20 000 per QALY.Conclusions: Three-monthly screening for CT and NG among MSM on PrEP is not cost-effective compared with 6-monthly screening. The ICER becomes more favourable when a smaller fraction of all MSM at risk for an STI are screened. Reducing the screening frequency could be considered when the PrEP programme is established and the prevalence of CT and NG decline. [ABSTRACT FROM AUTHOR]

Currently, Europe is dealing with a large number of asylum seekers. A recent report show that attitudes toward asylum seekers are not that negative in the Netherlands, and yet Dutch citizens living close to asylum seeker centers barely have contact with them. Because contact is vital for a multicultural society, we investigated the facilitators and barriers for Dutch citizens to establish and maintain contact with asylum seekers where they live close together. We conducted semistructured interviews with Dutch people and analyzed them using thematic analysis. We found four themes: Physical possibilities for Contact, Goals for Contact, Social Identities, and Positivity and Openness, and proposed a grounded theory model based on how the themes are related. The findings are discussed in relation to debates on multiculturalism and intergroup tolerance, and can be used to improve the integration policies by local governments, because they present clear conditions and practical information as to how contact can be established and maintained. [ABSTRACT FROM AUTHOR]

This study investigates determinants for offering help to family members, neighbours and friends, based on the Informal Care Model. We do so in pooled representative data for the Netherlands collected in 2014 and 2016 (persons >17 years, n = 13,165). One‐third provides informal care to a person with health problems or impairments: partners (4%, n = 671), parents or children (16%, n = 2,381), distant relatives (6%, n = 858), friends or neighbours (6%, n = 839). Marginal effects show differences in the associations of care‐giving relationships with sociodemographic factors, barriers and beliefs. Helping a partner is related to age, gender (older people and men are more likely to help) and household composition (singles help less often). Care for close family is given often by 45–64 year olds, women, multiperson households and those with strong family beliefs. Helping second‐degree relatives correlates with age (young people help more often), barriers (those living with children help less often) and beliefs (people with professional background in care and people who attend church or mosque helping more often). Providing non‐kin care is associated with age and education level (young people less likely to help, people with a high education more likely), barriers (having a fulltime job) and beliefs (work experience in care, church or mosque attendance and norms). The supply of care to partners and close family is mainly associated with sociodemographic factors and barriers while the provision of care to distant family and non‐kin is also correlated with beliefs. If desirable policy is to create more informal care, investment in the combination of work and informal care, childcare and supportive arrangements for older community living couples is recommended. It also might be worthwhile to enhance beliefs about the usefulness of helping each other in times of need. [ABSTRACT FROM AUTHOR]

The aim of this study was to explore cross‐level mechanisms stimulating employees' innovative behavior in small firms, specifically emotional contagion between small business owners and their employees. Using data from three European countries and applying a multilevel approach, we tested how small business owners' work‐related affect—enthusiasm and comfort—relate to their employees' work‐related affect and innovative work behavior. The sample consisted of 85 small business owners and 711 employees from firms operating in the Netherlands, Poland, and Spain. Controlling for country, the results of multilevel modeling showed that small business owners' work‐related affect was positively related to their employees' work‐related affect. The hypothesized contagion of work‐related affect in small firms was, thus, supported. Employees' work‐related affect, in turn, was positively associated with their innovative behavior. Employees' work‐related affect mediated the relationship between small business owners' work‐related affect and employees' innovative behavior. The results also showed cross‐country differences in the strength of some of the relationships. The study is a step forward in understanding innovation in small firms, extending the insights gained from single‐level investigations. [ABSTRACT FROM AUTHOR]

This study proposes a risk analysis approach for complex healthcare processes that combines qualitative and quantitative methods to improve patient safety. We combine Healthcare Failure Mode and Effect Analysis with Computer Simulation (HFMEA-CS), to overcome widely recognised HFMEA drawbacks regarding the reproducibility and validity of the outcomes due to human interpretation, and show the application of this methodology in a complex healthcare setting. HFMEA-CS is applied to analyse drug adherence performance in the surgical admission to discharge process of pheochromocytoma patients. The multidisciplinary team identified and scored the failure modes, and the simulation model supported in prioritisation of failure modes, uncovered dependencies between failure modes, and predicted the impact of measures on system behaviour. The results show that drug adherence, defined as the percentage of required drugs received at the right time, can be significantly improved with 12%, to reach a drug adherence of 99%. We conclude that HFMEA-CS is both a viable and effective risk analysis approach, combining strengths of expert opinion and quantitative analysis, for analysing human-system interactions in socio-technical systems. Practitioner summary: We propose combining Healthcare Failure Mode and Effects Analysis with Computer Simulation (HFMEA-CS) for prospective risk analysis of complex and potentially harmful processes, to prevent critical incidents from occurring. HFMEA-CS combines expert opinions with quantitative analyses, such that the results are more reliable, reproducible, and fitting for complex healthcare settings. [ABSTRACT FROM AUTHOR]