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A scrapbook compiled between 1660 and 1687 by Gesina ter Borch (1631–1690), a female artist from the small town of Zwolle in the Netherlands, contains an intriguing painting on paper of a full-length portrait of a young Iranian. Although the figure wears the attributes in vogue at the Safavid court of Isfahan, certain elements seem rather incongruous and peculiar. The general composition appears static and rigid, an impression reinforced by an unusual black painted background. Stylistic differences within the painting were also observed, hinting at alterations to the original painting. To investigate the history of the painting and to reconstruct the original composition and identify the later additions, perhaps made by Gesina herself, the painting was examined with different imaging and analytic techniques available at the Conservation and Science Department of the Rijksmuseum. This allowed the research team to discriminate between pigments used for the original composition and pigments used to conceal damaged areas of the painting and added pictorial elements. After interpreting scientific results, as well as historical findings, it was possible to shed light on the use of specific pigments, namely lead white and smalt, and on the possible misinterpretation of some details, such as the cup held by the young man. The results of macro X-ray fluorescence scanning (MA-XRF) and lead isotope analysis, viewed in the light of information about the economic and cultural exchanges between Iran and the Netherlands in the seventeenth century, fed new theories about the origin and history of this painting. The painting, originally made in Iran in the style of Riza Abbasi, the head of the Emperor Shah Abbas' library, ended up in Gesina ter Borch's workshop and may have been 'restored' by the artist to improve its condition and to match her tastes. [ABSTRACT FROM AUTHOR]

Introduction: This study presents a global research scenario in the broad domain of osteoarthritis (OA) research, using quantitative and qualitative publication and citation indicators. Methods: The study is based on 45,368 global publications, sourced from the Scopus bibliographical database, covering three decades (1994–2023). We studied the performance of the top 12 developed and top 12 developing countries. The key countries, organizations and authors at national and international levels were identified. The broad subject areas and key journals contributing to global OA research were delineated, besides identifying the broad characteristics of highly cited papers in the field. Results: The United States and China were the most productive countries, while the Netherlands and Canada made the largest citation impact. Harvard Medical School and the University of Sydney made the most contribution, while Boston University and Pfizer Inc., USA registered the highest citation impact. Hunter DJ and Guermazi A were the most productive authors, while Lohmander LS, and Hochberg MC registered the highest citation impact. Osteoarthritis and Cartilage (n = 4879) and Annals of the Rheumatic Diseases (n = 786) published the maximum papers, while Arthritis and Rheumatism and Nature Reviews Rheumatology registered the largest citation impact. The highly cited papers with 100 or more citations constituted 6.25% of the total publications. Conclusions: There has been a systematic growth of publications on OA. The research on OA was mainly done in developed countries, with the maximum publications coming from the United States of America, China and Canada. The most impactful publications on OA were from the Netherlands, Canada and the United States of America. [ABSTRACT FROM AUTHOR]

Background: This study takes on the challenge of quantifying a complex causal loop diagram describing how poverty and health affect each other, and does so using longitudinal data from The Netherlands. Furthermore, this paper elaborates on its methodological approach in order to facilitate replication and methodological advancement. Methods: After adapting a causal loop diagram that was built by stakeholders, a longitudinal structural equation modelling approach was used. A cross-lagged panel model with nine endogenous variables, of which two latent variables, and three time-invariant exogenous variables was constructed. With this model, directional effects are estimated in a Granger-causal manner, using data from 2015 to 2019. Both the direct effects (with a one-year lag) and total effects over multiple (up to eight) years were calculated. Five sensitivity analyses were conducted. Two of these focus on lower-income and lower-wealth individuals. The other three each added one exogenous variable: work status, level of education, and home ownership. Results: The effects of income and financial wealth on health are present, but are relatively weak for the overall population. Sensitivity analyses show that these effects are stronger for those with lower incomes or wealth. Physical capability does seem to have strong positive effects on both income and financial wealth. There are a number of other results as well, as the estimated models are extensive. Many of the estimated effects only become substantial after several years. Conclusions: Income and financial wealth appear to have limited effects on the health of the overall population of The Netherlands. However, there are indications that these effects may be stronger for individuals who are closer to the poverty threshold. Since the estimated effects of physical capability on income and financial wealth are more substantial, a broad recommendation would be that including physical capability in efforts that are aimed at improving income and financial wealth could be useful and effective. The methodological approach described in this paper could also be applied to other research settings or topics. [ABSTRACT FROM AUTHOR]

Abstract: The pulp and paper industry both uses and produces large amounts of energy and rising fuel prices bring along significant challenges to the sector. Several strategies can be applied in order to remain competitive e.g. an increase in energy efficiency, a switch in fuel and/or a novel energy conversion technology. In this study, we investigate if improved energy conversion strategies can reduce energy costs, primary energy use and CO2 emissions of paper mills within different European countries (The Netherlands, Poland and Sweden). Our results show that differences in history and availability of resources has led to different conversion strategies in the three countries. We found that a natural gas combined cycle, which is largely implemented in The Netherlands due to long term domestic availability of natural gas, has the lowest primary energy demand. Due to a long history of low electricity prices, CHP has not been common in Sweden. Many Swedish mills use biomass as an energy source and due to low CO2 emissions of the national grid the CO2 emission profile of the Swedish paper industry is very low. Our results imply that future conversion routes for the Swedish paper and board industry are again wood based; in case of increasing electricity prices these would be biomass gasification based CHP solutions. With a reduction of 800kg CO2/ton paper on average, a switch from coal to biomass would reduce CO2 emissions in the Polish pulp and paper industry with approximately 0.6Mton/year. A carbon price of 20–25€/ton would, according to our results, be enough to provoke this switch. Due to the high share of natural gas, the CO2 emission reduction potential of the Dutch paper industry (1.5Mton/year) is even larger than in Poland. Due to high biomass prices and relative low CO2 emission profile of natural gas, a carbon prices of more than 60€/ton CO2 would be needed to provoke a switch in The Netherlands. Provided with few alternatives, the most effective strategy in The Netherlands would be an increase in energy efficiency. [Copyright &y& Elsevier]

The EU has set the ambitious target of raising the share of EU energy consumption produced from renewable resources to 32% by 2030, with a target of climate neutrality by 2050. The aim of this paper is to assess the role of biomass usage in the context of these targets. The paper identifies the progress made between 2013 and 2022 by focusing on a selection of EU countries. The largest bioenergy increments of 130, 77, and 60 PJ were reported for Poland, Sweden, and the Netherlands. This study evaluates the crucial role of co-generation and heat in EU regions, with biomass usage between 55 and 80% of the combined heat and power (CHP) energy in Nordic countries. The future perspectives for bioenergy based on EU policies, biomass resources, and technical issues were addressed. The EU possesses around 9% of the global biomass supply, ensuring a certain level of biomass resource dependence. Thus, the biomass usage demand in energy production, non-energy sectors, and transport is expected to rise, leading to increments of 13–76% on biomass imports. It appears that bioenergy development is mostly limited by economic issues and uneven support for bioenergy in different EU countries as well as environmental issues. The study shows a promising and sustainable potential of bioenergy in the EU as a renewable energy source while minimizing negative impacts on the environment and the economy. By 2050, liquid biofuels are likely to be increasingly used in the transport sector. Non-energy sector usage of biomass is still in an early stage of development, except for the pulp and paper industry, and significant use of biomass in non-energy sectors seems unlikely in the near future. [ABSTRACT FROM AUTHOR]

Abstract: In the policy-making process concerning energy and environmental issues, cooperation between government and firms is a means to create a more efficient energy and environmental policy. Intermediary organizations can play an important role in this policy-making process. Aim of this study is to get insight into the role of one specific intermediary organization: the industry association. In this paper, we focus on the Dutch paper and board industry. Important policy themes for this industry are waste water, waste, and energy efficiency. We distinguished four types of governmental policy instruments: top-down regulation, interactive regulation, negative economic instruments, and positive economic instruments. We analyzed the role of the industry association in the policy-making process for all of these four instruments. The results clearly show different (relative) roles of the industry association in different steps of the policy-making processes and for different types of instruments. [Copyright &y& Elsevier]

This review is aimed at summarizing the current state of knowledge about the relationship between environmental exposure to the bioaerosol emitted by intensive livestock farming and changes in the microbiome of people living in livestock farm vicinity. The PubMed, Scopus and Web of Science databases were searched by crossing keywords from the following 3 groups: a) "livestock," "animal farms," "animal breeding"; b) "microbiome," "resistome"; c) "livestock vicinity," "farm vicinity," "neighborhoods and health" in 2010-2022. Literature screening did not reveal any paper related to the full microbiome composition in the population studied. In the study, the authors included 7 papers (5 from the Netherlands, 1 from the USA, and 1 from China). The studies confirmed the carriage of Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA), livestockassociated MRSA (LA-MRSA MC398) and multidrug-resistant S. aureus (MDRSA) in the nasal microbiome of adults and children living within 500-2000 m from a livestock farm. Clostridium difficile, including LA-ribotype RT078 carriage, was detected in the intestinal microbiome of adults living within 500-1000 m. Extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae were confirmed in the intestinal microbiome of adults living within 500-6200 m. Knowledge on the composition of the microflora of people living in livestock farm vicinity is insufficient to conclude about changes in the microbiome caused by the environmental emission of bioaerosol. The carriage prevalence of the LA-bacteria, including both strains with antimicrobial resistance and antimicrobial resistance genes, confirms the presence of zoonotic bacteria in the human microflora in populations without occupational contact with animals. It cannot be ruled out that zoonotic bacteria, as a component of the microbiome, have a negative impact on people's health. Int J Occup Med Environ Health. 2024;37(2):138-52. [ABSTRACT FROM AUTHOR]

Background: The role of patient participation and representation during crises, such as the COVID‐19 pandemic, has been under‐researched. Existing studies paint a pessimistic picture of patient representation during the pandemic. However, there are indications that patient representatives have adapted to the new situation and can contribute to the resilience of healthcare systems. This paper aims to further explore the potential contribution of patient representatives for healthcare system resilience during the COVID‐19 pandemic. Methods: The study used a qualitative approach. We conducted a thematic analysis on the following data: interviews with client council members (n = 32) and representatives from patient organizations (n = 6) and focus groups (n = 2) to investigate patient representation on both the national policy level and organizational level in the Netherlands. Results: We identified the crisis discourse, the dependent position, the diversity of patient perspectives and the layered decision‐making structure as themes that help to understand what made patient representation in pandemic times a struggle for national and local patient representatives. The analysis of the subjects these representatives put forward during decision‐making shows that their input can play an important role in broadening discussions, challenging decisions, and suggesting alternatives during a crisis. We identified several strategies (e.g., collaborating with other actors, proactively putting subjects on the policy agenda, finding new ways of contacting their 'constituency') used by the patient representatives studied to exert influence despite the difficulties encountered. Conclusions: The struggle for patient representation during pandemic decision‐making is a missed opportunity for resilient healthcare systems as these representatives can play a role in opening up discussions and putting different perspectives to the fore. Moreover, the adaptive strategies used by representatives to influence decision‐making offer lessons for future representation activities. However, adaptations to the crisis decision‐making structure are also needed to enable patient representatives to play their role. Patient Contribution: We conducted interviews with patient representatives and discussed our preliminary findings with patient representatives during the focus groups. Zorgbelang, a patient organization supporting client councils and enabling and organizing patient participation for organizations and municipalities, was partner in this research and contributed to the interview guide, conducting interviews and focus groups. Additionally, the analysis made by the first author was discussed and refined multiple times with the partners of Zorgbelang and one of them co‐authored this paper. [ABSTRACT FROM AUTHOR]

Objective: Much research on the early stages of the COVID-19 pandemic demonstrates the unequal impact on men and women in many countries but empirical evidence on later stages of the pandemic remains limited. The objective of this paper is to study differences between men and women in work location, the relative division of childcare, and perceived work-life balance across and throughout different phases of the pandemic using six waves of probability-based survey data collected in the Netherlands between April 2020 and April 2022 (including retrospective pre-pandemic measures). Method: The study used descriptive methods (longitudinal crosstabulations) and multivariate modelling (cross-sectional multinomial logits, with and without moderators) in a repeated cross-sectional design. Results: Results suggest the pandemic is associated with several phase-specific differences between men and women in where they worked and their relative division of childcare in the Netherlands. Men were less likely than women to work fully from home at the start of each lockdown and to work on location during the first lockdown. Amongst parents, fathers increased their share of childcare throughout the first phase of the pandemic, and this increase remains visible at the end of the pandemic. Women in the Netherlands did not experience worse work-life balance than men throughout the pandemic, but mothers did experience worse work-life balance than fathers at various points during the pandemic. Discussion: Our results suggest varying long-term implications for gender inequality in society. Gender differences in work location raise concerns about the possible longer-term impact on gender inequalities in career development. Our findings on childcare suggest that many households have experienced different divisions of childcare at different stages of the pandemic, with some potential for longer-term change. Conclusion: Inequalities between men and women in work, childcare, and wellbeing have neither been alleviated by nor unilaterally worsened during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: BERT models have seen widespread use on unstructured text within the clinical domain. However, little to no research has been conducted into classifying unstructured clinical notes on the basis of patient lifestyle indicators, especially in Dutch. This article aims to test the feasibility of deep BERT models on the task of patient lifestyle classification, as well as introducing an experimental framework that is easily reproducible in future research. Methods: This study makes use of unstructured general patient text data from HagaZiekenhuis, a large hospital in The Netherlands. Over 148 000 notes were provided to us, which were each automatically labelled on the basis of the respective patients' smoking, alcohol usage and drug usage statuses. In this paper we test feasibility of automatically assigning labels, and justify it using hand-labelled input. Ultimately, we compare macro F1-scores of string matching, SGD and several BERT models on the task of classifying smoking, alcohol and drug usage. We test Dutch BERT models and English models with translated input. Results: We find that our further pre-trained MedRoBERTa.nl-HAGA model outperformed every other model on smoking (0.93) and drug usage (0.77). Interestingly, our ClinicalBERT model that was merely fine-tuned on translated text performed best on the alcohol task (0.80). In t-SNE visualisations, we show our MedRoBERTa.nl-HAGA model is the best model to differentiate between classes in the embedding space, explaining its superior classification performance. Conclusions: We suggest MedRoBERTa.nl-HAGA to be used as a baseline in future research on Dutch free text patient lifestyle classification. We furthermore strongly suggest further exploring the application of translation to input text in non-English clinical BERT research, as we only translated a subset of the full set and yet achieved very promising results. [ABSTRACT FROM AUTHOR]

Background: Informal care features high on the policy agenda of many countries to deal with workforce shortages. As a consequence, care provision increasingly takes place in the care triad of care recipients, informal caregivers and care professionals. How collaboration between care partners takes shape depends on how the different partners perceive this collaboration. This paper aims to investigate the relative importance of the different aspects of collaboration from the perspectives of care recipients, informal caregivers and care professionals in the context of the care for older persons in The Netherlands. Methods: Using Q‐methodology, 32 participants ranked 28 statements that reflect different aspects of collaboration in the care triad and explained their ranking during a follow‐up interview. Participants comprised 9 older persons, 10 informal caregivers and 13 care professionals. Data were analysed using by‐person factor analysis to identify common patterns in the rankings of the statements. Emerging patterns were interpreted and described as views on collaboration using aggregated rankings and qualitative data from the interviews. Results: Five distinct views on collaboration were found: (1) Emphasizing warm collaboration, (2) trusting care professional's expertise, (3) open and compassionate care professionals, (4) responsive decision‐making by autonomous care professionals and (5) prioritizing care recipient's and informal caregiver's interests. Care recipients and/or informal caregivers were associated with views 1, 3 and, 5, whereas care professionals were associated with all five views. Conclusions: Our study highlights the importance of recognizing the potential diversity of views between and within different partner groups in care triads. Governmental and organizational policy makers, as well as healthcare professionals who aim to increase or support the involvement of informal caregivers, should take this heterogeneity into consideration. Patient or Public Contribution: An advisory board of older persons (care recipients and informal caregivers) was involved in the recruitment of the participants, the formulation of the statements and the reflection on the findings of the study and potential implications. [ABSTRACT FROM AUTHOR]

This paper introduces three new scales to measure left- and right-wing radical as well as general extremist attitudes that can be applied across Western European countries. We therefore propose a thorough conceptualization of extremist attitudes that consists of two dimensions: general extremism, by which we understand attitudes that oppose the constitutional democratic state, and another dimension that differentiates between right- and left-wing radicalism by which we understand people who take far-reaching but often one-sided positions on political issues (e.g., on nationalism or anti-imperialism) by advocating fundamental socio-political change. Based on data from Germany, Great Britain, and the Netherlands (n = 6,201) we created short indices for general extremism and left- and right-wing radicalism. We check for convergence validity by assessing the psychometric properties of the extracted indices, i.e. their internal coherence and the degree to which a scale is able to distinguish strongly extremist and non-extremist individuals. Finally, we correlate the scales with various constructs that are likely related to extremist attitudes in order to assure external or construct validity. The results indicate that the three scales are highly valid and applicable across three Western European countries. Overall, we find that about two to four percent of citizens in each country hold left-wing or right-wing extremist attitudes. [ABSTRACT FROM AUTHOR]

Objective: Hospitals and healthcare providers should assess and compare the quality of care given to patients and based on this improve the care. In the Netherlands, hospitals provide data to national quality registries, which in return provide annual quality indicators. However, this process is time-consuming, resource intensive and risks patient privacy and confidentiality. In this paper, we presented a multicentric 'Proof of Principle' study for federated calculation of quality indicators in patients with colorectal cancer. The findings suggest that the proposed approach is highly time-efficient and consume significantly lesser resources. Materials and methods: Two quality indicators are calculated in an efficient and privacy presevering federated manner, by i) applying the Findable Accessible Interoperable and Reusable (FAIR) data principles and ii) using the Personal Health Train (PHT) infrastructure. Instead of sharing data to a centralized registry, PHT enables analysis by sending algorithms and sharing only insights from the data. Results: ETL process extracted data from the Electronic Health Record systems of the hospitals, converted them to FAIR data and hosted in RDF endpoints within each hospital. Finally, quality indicators from each center are calculated using PHT and the mean result along with the individual results plotted. Discussion and conclusion: PHT and FAIR data principles can efficiently calculate quality indicators in a privacy-preserving federated approach and the work can be scaled up both nationally and internationally. Despite this, application of the methodology was largely hampered by ELSI issues. However, the lessons learned from this study can provide other hospitals and researchers to adapt to the process easily and take effective measures in building quality of care infrastructures. [ABSTRACT FROM AUTHOR]

Introduction: Women at increased risk of developing pre-eclampsia are advised to take a daily low-dose of aspirin from 12 weeks of pregnancy to reduce their risks. Despite the well-established prophylactic effect of aspirin, adherence to this therapy is low. This systematic review aimed to summarise evidence on the barriers and facilitators of adherence to low-dose aspirin to inform intervention development to support decision making and persistence with aspirin use for pre-eclampsia prevention. Materials and methods: A systematic review and meta-synthesis of qualitative research was co-produced by representatives from charities, and public, clinical and academic members. Eight electronic databases (MEDLINE, PsycINFO, CINAHL, Web of Science, Scopus, EMBASE, Prospero, OpenGrey), archives of charities and professional organisations were searched (between October and November 2023 and re-run in August 2023) using predefined search terms. Studies containing qualitative components related to barriers and facilitators of adherence to low-dose aspirin during pregnancy were included. Quality assessment was performed using the Critical Appraisal Skills Programme checklist for qualitative research. A combination of the COM-B framework with phases of adherence process as defined by international taxonomy was used as the coding framework. Co-production activities were facilitated by use of 'Zoom' and 'Linoit'. Results: From a total of 3377 papers identified through our searches, five published studies and one dissertation met our inclusion criteria. Studies were published from 2019 to 2022 covering research conducted in the USA, Canada, UK, Netherlands and Australia. Barriers and facilitators to adherence were mapped to six categories of the COM-B for three phases of adherence: initiation, implementation, and discontinuation. The discontinuation phase of adherence was only mentioned by one author. Four key themes were identified relating to pregnancy: 'Insufficient knowledge', 'Necessity concerns balance', 'Access to medicine', 'Social influences', and 'Lack of Habit'. Conclusions: The COM-B framework allowed for detailed mapping of key factors shaping different phases of adherence in behavioural change terms and now provides a solid foundation for the development of a behavioural intervention. Although potential intervention elements could be suggested based on the results of this synthesis, additional co-production work is needed to define elements and plan for the delivery of the future intervention. Trial registration: PROSPERO CRD42022359718. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359718. [ABSTRACT FROM AUTHOR]

The dataset includes data from the two studies reported in our 'Terror Management in a Multicultural Society' paper. The data was collected at the psychology lab at the Vrije Universiteit Amsterdam in 2013/2014 among Dutch-speaking student samples. The dataset consists of the measures described in the paper. The data can be used for replication purposes, meta-analyses, and exploratory analyses, as well as cross-cultural comparisons of mortality salience effects. The authors also welcome collaborative research based on re-analyses of the data. [ABSTRACT FROM AUTHOR]

Sustainable intensification of agriculture requires understanding of the effect of soil characteristics and nutrient supply on crop growth. As farms are increasing in size by acquiring small fields from various farmers, the soil characteristics and nutrient supply might be very different from field to field, while at the same time specific soil properties might limit the nutrient uptake. As a result, there might be a large number of heterogeneous reasons why crop growth varies significantly. New data analysis techniques can help to explain variability in crop growth among fields. This paper introduces Exceptional Growth Mining (EGM) as a first contribution. EGM instantiates the data mining framework Exceptional Model Mining (EMM) such that subgroups of fields can be found that grow exceptionally in terms of three growth parameters (high/low maximum growth, steep/flat linear growth and early/late midpoint of maximum growth). As second contribution, we apply EGM to a case study by analyzing the dataset of a potato farm in the south of the Netherlands. EGM consists of (i) estimating growth curves by applying nonlinear mixed models, (ii) investigating the correlation between the estimated growth parameters, and (iii) applying EMM on these growth curve parameters using a growth curve-specific quality measure. By applying EGM on the data of the potato farm, we obtain the following results: 1) the estimated growth curves represent the variability in potato tuber growth very well (R2 of 0.92), 2) the steepness of the growth curve has a strong correlation with the maximum growth and the midpoint of maximum growth, and the correlation between the midpoint of maximum growth and maximum growth is weak, 3) the subgroup analyses indicate that: high values of K correspond to high maxima; low values of K correspond to low maxima, steep growth curves', and a late midpoint of halfway growth; Mg influences the midpoint of the growth curve; values of B are higher on dry soils with high tuber growth, while low values of B are found on wet soils with high tuber growth; high values of Zn, Mn, and Fe are found in subgroups with low tuber weight, probably related to the soil's low pH. In summary, this paper introduces EGM to obtain understanding in crop response to soil properties and nutrient supply. In addition, EGM provides a way to analyze only small parts of a large dataset, such that the impact of soil factors on growth can be analyzed on a more detailed level than existing methods. [ABSTRACT FROM AUTHOR]

Renewable energy infrastructures, such as wind and solar farms, require land on which they can be deployed. While politics and conflicts over accessing land for renewables are well documented, the role, conditions and potential agency of landownership have been often overlooked or oversimplified as a powerful terrain in the field of renewables development. In this paper, we explore the relationship between landed property and community renewable energy projects. In particular, we focus on how landed property variously influences the development modes of renewables by acting as a mediator, barrier and enabler for different types of wind energy projects. We show how this takes place through appropriation of rents in processes of assetisation and value grabbing by landowners. In this way, value grabbing acts as a vital intermediary process to understand green grabbing and wider processes of capital accumulation through renewables. We draw on insights from the Netherlands and Scotland to illuminate different mechanisms, social and historical conditions, and policies through which landed property constrains or enables community wind energy projects. The paper finishes by sketching out some alternative ways of allocating land for the deployment of renewable energy projects, which could help shift the balance of power in favour of community energy developments. [ABSTRACT FROM AUTHOR]

Aim: To investigate spoken language comprehension (SLC), single‐word comprehension (SWC), functional communication development, and their determinants, in children with cerebral palsy. Method: This was a prospective cohort study in the Netherlands spanning 2 years 6 months. The main outcomes were SLC and SWC, assessed by the Computer‐Based instrument for Low motor Language Testing (C‐BiLLT) and the Peabody Picture Vocabulary Test‐III‐NL (PPVT‐III‐NL) respectively; and functional communication, measured by a subscale of the Focus on the Outcomes of Communication Under Six‐34 (FOCUS‐34). Linear mixed models were used to determine developmental trajectories, which were compared with norm and reference data. Potential determinants, for example intellectual functions, speech production, functional communication level (classified with the Communication Function Classification System, CFCS), and functional mobility, were added to assess their effects. Results: Children with cerebral palsy (n = 188; mean age 59 months, range 17–110) were monitored for 2 years 6 months. Developmental trajectories for SLC (C‐BiLLT) and SWC (PPVT‐III‐NL) were nonlinear; those for functional communication (FOCUS‐34) were linear. Compared with norm and reference groups, significantly delayed SLC, SWC, and functional communication development were found. Determinants for SLC and SWC were intellectual functions and functional communication level (CFCS); and for functional communication development (FOCUS‐34), speech production and arm–hand functioning. Interpretation: Children with cerebral palsy showed delayed SLC, SWC, and functional communication development compared with norm and reference groups. Remarkably, functional mobility was not associated with the development of SLC, SWC, or functional communication. What this paper adds: Children with cerebral palsy have delayed spoken language comprehension (SLC), single‐word comprehension (SWC), and functional communication development, compared to norm and reference data.Determinants for SLC and SWC development are intellectual functions and functional communication level.Determinants for functional communication development are speech production and arm–hand functioning.Functional mobility is not associated with SLC, SWC, or functional communication. What this paper adds: Children with cerebral palsy have delayed spoken language comprehension (SLC), single‐word comprehension (SWC), and functional communication development, compared to norm and reference data.Determinants for SLC and SWC development are intellectual functions and functional communication level.Determinants for functional communication development are speech production and arm–hand functioning.Functional mobility is not associated with SLC, SWC, or functional communication. Video Podcast: https://youtu.be/x09Tac7tsz0 [ABSTRACT FROM AUTHOR]

Background: Intervention planners use logic models to design evidence-based health behavior interventions. Logic models that capture the complexity of health behavior necessitate additional computational techniques to inform decisions with respect to the design of interventions. Objective: Using empirical data from a real intervention, the present paper demonstrates how machine learning can be used together with fuzzy cognitive maps to assist in designing health behavior change interventions. Methods: A modified Real Coded Genetic algorithm was applied on longitudinal data from a real intervention study. The dataset contained information about 15 determinants of fruit intake among 257 adults in the Netherlands. Fuzzy cognitive maps were used to analyze the effect of two hypothetical intervention scenarios designed by domain experts. Results: Simulations showed that the specified hypothetical interventions would have small impact on fruit intake. The results are consistent with the empirical evidence used in this paper. Conclusions: Machine learning together with fuzzy cognitive maps can assist in building health behavior interventions with complex logic models. The testing of hypothetical scenarios may help interventionists finetune the intervention components thus increasing their potential effectiveness. [ABSTRACT FROM AUTHOR]

The use of radiation to treat keloid scars has gained popularity during the last few decades. However, few bibliometric analyses have been performed on the published articles. This research aimed to demonstrate and evaluate the trends, top-cited articles, and frontier areas. In this cross-sectional study, Web of Science (WOS) and Scopus database literature was searched for all MESH terms related to "keloid" and "radiotherapy." The bibliometric analysis was carried out by VOSviewer 1.6.15. Articles with Web of Science-based citations of ≥20 were included. The citation per year index (CPYI) of articles was calculated for further inclusion of papers if they had CPYI higher than the mean value. There were 95 papers on keloid radiation that satisfied the inclusion criteria and were published between 1942 and 2019. The CPYI ranged from 0.38 to 11.3. Most studies were published in the "International Journal of Radiation Oncology, Biology, and Physics" (9 papers). The United States has the most papers (14), followed by Japan (9), the Netherlands (7), and Germany (5). To the best of our knowledge, this is the first bibliometric analysis of top-cited papers on keloid radiotherapy. From 2014 to the present, it seems that this title has resurfaced as a popular topic, with radiotherapy within 24 h of surgery being the most commonly recommended treatment plan. Since around 2011, high-dose-rate brachytherapy (HDR-BT) has been used as an effective treatment for keloid control. Individualization of therapy and dose/technique based on the location is strongly suggested. [ABSTRACT FROM AUTHOR]

BACKGROUND: Posttraumatic stress disorder (PTSD) is often associated with impaired fear inhibition and decreased safety cue processing; however, studies capturing the cognitive aspect of inhibition and contextual cue processing are limited. In this fMRI study, the role of contextual cues in response inhibition was investigated. METHODS: Male medication-naive war veterans with PTSD, male control veterans (combat controls) and healthy nonmilitary men (healthy controls) underwent fMRI while performing the stop-signal anticipation task (SSAT). The SSAT evokes 2 forms of response inhibition: reactive inhibition (outright stopping) and proactive inhibition (anticipation of stopping based on contextual cues). RESULTS: We enrolled 28 veterans with PTSD, 26 combat controls and 25 healthy controls in our study. Reduced reactive inhibition was observed in all veterans, both with and without PTSD, but not in nonmilitary controls, whereas decreased inhibition of the left pre/postcentral gyrus appeared to be specifically associated with PTSD. Impaired behavioural proactive inhibition was also specific to PTSD. Furthermore, the PTSD group showed a reduced right inferior frontal gyrus response during proactive inhibition compared with the combat control group. LIMITATIONS: Most patients with PTSD had comorbid psychiatric disorders, but such comorbidity is common in patients with PTSD. Also, the education level (estimate of intelligence) of participants, but not of their parents, differed among the groups. CONCLUSION: Our findings of reduced proactive inhibition imply that patients with PTSD show reduced contextual cue processing. These results complement previous findings on fear inhibition and demonstrate that contextual cue processing in patients with PTSD is also reduced during cognitive processes, indicating a more general deficit. [ABSTRACT FROM AUTHOR]

Streptococcus suis (S. suis) infections in weaned pigs are common and responsible for a high consumption of antimicrobials, and their presence is assumed to be multi-factorial. A specific evidence-based veterinary guideline to support the control of S. suis in weaned pigs was developed for veterinary practitioners in the Netherlands in 2014. Adherence to the S. suis clinical practice guideline helps veterinary practitioners to prevent and control the disease in a systematical approach and thereby improve antimicrobial stewardship and contribute to the prevention of antimicrobial resistance in animals and humans. The impact of such a clinical practice guideline on (animal) disease management depends not only on its content, but also largely on the extent to which practitioners adhere to the clinical guideline in practice. When the S. suis guideline was published, no specific activities were undertaken to support veterinarians' uptake and implementation, thereby contributing to suboptimal adherence in clinical practice. As the S. suis guideline was comprehensively written by veterinary experts following an evidence-based approach, our aim was not to judge the (scientific) quality of the guideline but to study the possibility to improve the currently low adherence of this guideline in veterinary practice. This paper describes the systematic development, using Implementation Mapping, of a theory-based intervention program to support swine veterinarians' adherence to the S. suis guideline. The knowledge, skills, beliefs about capabilities, and beliefs about consequences domains are addressed in the program, which includes seven evidence-based methods (modelling, tailoring, feedback, discussion, persuasive communication, active learning, and self-monitoring) for use in program activities such as a peer-learning meeting and an e-learning module. The intervention program has been developed for practicing swine veterinarians, lasts eight months, and is evaluated through a stepped-wedge design. The Implementation Mapping approach ensured that all relevant adopters and implementers were involved, and that outcomes, determinants (influencing factors), and objectives were systematically discussed. [ABSTRACT FROM AUTHOR]

Background: Holistic housing renovations combine physical housing improvements with social and socioeconomic interventions (e.g. referral to social services, debt counselling, involvement in decision-making, promoting social cohesion). In a deprived neighbourhood in Utrecht, the Netherlands, this paper examined residents' and professionals' experiences, ideas, and perceptions regarding holistic housing renovation, its health effects, and underlying mechanisms explaining those effects. Methods: Semi-structured in-depth interviews were conducted with 21 social housing residents exposed to holistic housing renovation, and 12 professionals involved in either the physical renovation or social interventions implemented. Residents were interviewed in various renovation stages (before, during, after renovation). Transcripts were deductively and inductively coded using qualitative software. Results: Residents experienced and professionals acknowledged renovation stress caused by nuisance from construction work (noise, dust), having to move stuff around, and temporary moving; lack of information and control; and perceived violation of privacy. Involvement in design choices was appreciated, and mental health improvement was expected on the long term due to improved housing quality and visual amenity benefits. Social contact between residents increased as the renovation became topic for small talk. Few comments were made regarding physical health effects. The interviews revealed a certain amount of distrust in and dissatisfaction with the housing corporation, construction company, and other authorities. Conclusions: Renovation stress, aggravated by lack of information and poor accessibility of housing corporation and construction company, negatively affects mental health and sense of control. Potential stress relievers are practical help with packing and moving furniture, and increased predictability by good and targeted communication. Social interventions can best be offered after renovation, when residents live in their renovated apartment and the nuisance and stress from the renovation is behind them. Social partners can use the period leading up to the renovation to show their faces, offer practical help to reduce renovation stress, and increase residents' trust in their organization and authorities in general. This might also contribute to residents' willingness to accept help with problems in the social domain after renovation. [ABSTRACT FROM AUTHOR]

Long baseline bistatic radar systems herald enhanced sensitivity and metric accuracy for space objects in geosynchronous orbits and beyond. Radio telescopes are ideal participants in such a system; in particular, they often feature large apertures with low‐noise temperatures and have stable, synchronised clocks. Pairing radio telescopes with high‐power radars creates new methodologies for Space Domain Awareness. This paper describes long baseline bistatic measurements using the Millstone Hill Radar in the USA, the Tracking and Imaging Radar in Germany, multiple receivers of the enhanced multi‐element remotely linked interferometer network array in the United Kingdom, and the Westerbork Synthesis Radio Telescope in the Netherlands. The authors, a Research Task Group formed by the NATO Science and Technology Organisation Sensors and Electronic Technology Panel (SET‐293), performed novel bistatic and monostatic radar imaging experiments with real on‐orbit tumbling rocket bodies. These experiments on tumbling objects at near‐geosynchronous orbits highlight successful demonstrations of advanced bistatic Doppler characterisation across diverse imaging geometries. Specialised Doppler processing on tumbling targets, such as the Doppler superpulse algorithm, enables high‐fidelity rotation period estimation and determination of minimum target size. [ABSTRACT FROM AUTHOR]

Hydrogen can be produced from water, using electricity. The hydrogen can subsequently be kept in inventory in large quantities, unlike the electricity itself. This enables solar and wind energy generation to occur asynchronously from its usage. For this reason, hydrogen is expected to be a key ingredient for reaching a climate-neutral economy. However, the logistics for hydrogen are complex. Inventory policies must be determined for multiple locations in the network, and transportation of hydrogen from the production location to customers must be scheduled. At the same time, production patterns of hydrogen are intermittent, which affects the possibilities to realize the planned transportation and inventory levels. To provide policies for efficient transportation and storage of hydrogen, this paper proposes a parameterized cost function approximation approach to the stochastic cyclic inventory routing problem. Firstly, our approach includes a parameterized mixed integer programming (MIP) model which yields fixed and repetitive schedules for vehicle transportation of hydrogen. Secondly, buying and selling decisions in case of underproduction or overproduction are optimized further via a Markov decision process (MDP) model, taking into account the uncertainties in production and demand quantities. To jointly optimize the parameterized MIP and the MDP model, our approach includes an algorithm that searches the parameter space by iteratively solving the MIP and MDP models. We conduct computational experiments to validate our model in various problem settings and show that it provides near-optimal solutions. Moreover, we test our approach on an expert-reviewed case study at two hydrogen production locations in the Netherlands. We offer insights for the stakeholders in the region and analyze the impact of various problem elements in these case studies. Funding: This project received funding from the Fuel Cells and Hydrogen 2 Joint Undertaking (now Clean Hydrogen Partnership) under [Grant Agreement 875090]. The Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme, Hydrogen Europe and Hydrogen Europe Research. A. H. Schrotenboer received support from the Dutch Science Foundation (Nederlandse Organisatie voor Wetenschappelijk Onderzoek; NWO) through [Grant VI.Veni.211E.043]. [ABSTRACT FROM AUTHOR]

This paper considers the scheduling of electric vehicles in a public transit system. Our main innovation is that we take into account that charging stations have limited capacity, while also considering partial charging. To solve the problem, we expand a connection-based network in order to track the state of charge of vehicles and model recharging actions. We then formulate the electric vehicle scheduling problem as a path-based binary program, whose linear relaxation we solve using column generation. We find integer feasible solutions using two heuristics: price-and-branch and a diving heuristic, including acceleration strategies. We test the approach using data from the concession Gooi en Vechtstreek in the Netherlands, containing up to 816 trips. The diving heuristic outperforms the other heuristic and solves the entire concession within seven hours of computation time with an optimality gap of less than 3%. Supplemental Material: The online appendix is available at https://doi.org/10.1287/trsc.2022.0253. [ABSTRACT FROM AUTHOR]

System dynamics approaches are increasingly addressing the complexity of public health problems such as childhood overweight and obesity. These approaches often use system mapping methods, such as the construction of causal loop diagrams, to gain an understanding of the system of interest. However, there is limited practical guidance on how such a system understanding can inform the development of an action programme that can facilitate systems changes. The Lifestyle Innovations Based on Youth Knowledge and Experience (LIKE) programme combines system dynamics and participatory action research to improve obesity-related behaviours, including diet, physical activity, sleep and sedentary behaviour, in 10–14-year-old adolescents in Amsterdam, the Netherlands. This paper illustrates how we used a previously obtained understanding of the system of obesity-related behaviours in adolescents to develop an action programme to facilitate systems changes. A team of evaluation researchers guided interdisciplinary action-groups throughout the process of identifying mechanisms, applying the Intervention Level Framework to identify leverage points and arriving at action ideas with aligning theories of change. The LIKE action programme consisted of 8 mechanisms, 9 leverage points and 14 action ideas which targeted the system's structure and function within multiple subsystems. This illustrates the feasibility of developing actions targeting higher system levels within the confines of a research project timeframe when sufficient and dedicated effort in this process is invested. Furthermore, the system dynamics action programme presented in this study contributes towards the development and implementation of public health programmes that aim to facilitate systems changes in practice. [ABSTRACT FROM AUTHOR]

Background: Osteogenesis Imperfecta (OI) is characterised by bone fragility. Among several features, easy bruising and multiple case reports on haemorrhagic events have been reported. This paper describes the diverse manifestations of bleeding and bruising in a large cohort of 328 OI patients. The aim of this study is to provide insight in the diverse aspects and therapeutic considerations of bleedings in OI. Methods: This descriptive cohort study was conducted at the National Expert Center for adults with OI in the Netherlands. Bleeding was assessed by the validated self-bleeding assessment tool (Self-BAT) The tool was distributed among 328 adults with different clinically confirmed types of OI. Results: 195 of 328 invited patients (completion rate 60%) with OI type 1 (n = 144), OI type 3 (n = 17) and OI type 4 (n = 34), aged between 18 and 82 years, completed the tool. Self-BAT scores were above the normal range in 42% of all patients. For males Self-BAT scores were increased in 37% with a mean score of 3.7, ranged between 0 and 18. For females the Self-BAT scores were increased in 44% with a mean of 5.4 and a range of 0–24. No statistical differences in OI subtypes were found. Conclusions: Bleeding tendency appears to be a relevant complication in OI patients as this study confirms the presumption of bleeding tendency. There are specific recommendations to clinicians who treat OI patients to consider an assessment of bleeding tendency and use potential interventions to reduce haemorrhagic complications and improve quality of life. [ABSTRACT FROM AUTHOR]

Background: User involvement and participation in the supervision of the quality of care is an important topic for many healthcare inspectorates. It offers regulators an additional view on quality, increases the legitimacy and accountability of the inspectorate, empowers users and enhancing the public's trust in the inspectorate. To assess the accessibility of the local governmental social domain services the Joint Inspectorate Social Domain in the Netherlands worked together with people with intellectual disabilities performing as 'mystery guests' in an innovative project. This paper describes the findings of the evaluation of this project. Methods: People with intellectual disabilities living at home on their own may need some help with daily activities such as administrative tasks, raising children, household tasks, managing debts or finding work. In the Netherlands they have to arrange this help at their municipality. The goal of this project was to find out how easily people with intellectual disabilities could get help from their municipality. The participants were equal partners with the JISD inspectors from the beginning: in constructing an inspection framework, in acting as mystery guest with a fictive support request, reported back the results by storytelling. Results: The evaluation of the project showed that the JISD succeeded in their key aspect of the project: the goal to involve people with intellectual disabilities in a leading role from the beginning until the end. Their perspectives and preferences were the starting point of supervision. Pain points in accessibility became clear straight away and gave important insights for both inspectors as municipality professionals. Municipalities started to improve their services and evaluated the improvements with the clients. Furthermore, the impact on the participants themselves was also huge: they felt being taken seriously, valued and empowered. Conclusion: Involving people with intellectual disabilities as participants in all phases of supervision processes contributes to more relevant and useful outcomes, creates mutual understanding of perspectives, as affirmed by both municipalities and inspectors, and creates empowerment of the participants. Furthermore, it fits perfectly within the United Nation Convention on the rights of persons with disabilities and the current development of 'value driven regulation'. [ABSTRACT FROM AUTHOR]

Background: Few examples exist of research capacity building (RCB) in midwifery. As in other jurisdictions, at the turn of this century midwives in the Netherlands lagged in research-based practice. Dutch professional and academic organisations recognised the need to proactively undertake RCB. This paper describes how a large national research project, the DELIVER study, contributed to RCB in Dutch midwifery. Methods: Applying Cooke's framework for RCB, we analysed the impact of the DELIVER study on RCB in midwifery with a document analysis comprising the following documents: annual reports on research output, websites of national organizations that might have implemented research findings, National Institute for Public Health and the Environment (RIVM)), midwifery guidelines concerning DELIVER research topics, publicly available career information of the PhD students and a google search using the main research topic and name of the researcher to look for articles in public papers. Results: The study provided an extensive database with nationally representative data on the quality and provision of midwifery-led care in the Netherlands. The DELIVER study resulted in 10 completed PhD projects and over 60 publications. Through close collaboration the study had direct impact on education of the next generation of primary, midwifery care practices and governmental and professional bodies. Discussion: The DELIVER study was intended to boost the research profile of primary care midwifery. This reflection on the research capacity building components of the study shows that the study also impacted on education, policy, and the midwifery profession. As such the study shows that this investment in RCB has had a profound positive impact on primary care midwifery in the Netherlands. [ABSTRACT FROM AUTHOR]

The use of radiation to treat keloid scars has gained popularity during the last few decades. However, few bibliometric analyses have been performed on the published articles. This research aimed to demonstrate and evaluate the trends, top-cited articles, and frontier areas. In this cross-sectional study, Web of Science (WOS) and Scopus database literature was searched for all MESH terms related to "keloid" and "radiotherapy." The bibliometric analysis was carried out by VOSviewer 1.6.15. Articles with Web of Science-based citations of =20 were included. The citation per year index (CPYI) of articles was calculated for further inclusion of papers if they had CPYI higher than the mean value. There were 95 papers on keloid radiation that satisfied the inclusion criteria and were published between 1942 and 2019. The CPYI ranged from 0.38 to 11.3. Most studies were published in the "International Journal of Radiation Oncology, Biology, and Physics" (9 papers). The United States has the most papers (14), followed by Japan (9), the Netherlands (7), and Germany (5). To the best of our knowledge, this is the first bibliometric analysis of top-cited papers on keloid radiotherapy. From 2014 to the present, it seems that this title has resurfaced as a popular topic, with radiotherapy within 24 h of surgery being the most commonly recommended treatment plan. Since around 2011, high-dose-rate brachytherapy (HDR-BT) has been used as an effective treatment for keloid control. Individualization of therapy and dose/technique based on the location is strongly suggested. [ABSTRACT FROM AUTHOR]

Simple Summary: This paper explores why it is ethical to rehome all healthy laboratory animals after the experiments have finished. We describe our own rehoming experience from the joint Ani-mal Welfare Body of Utrecht University and the University Medical Centre Utrecht, the Nether-lands. During a pilot period, over 350 animals were successfully rehomed. Now, rehoming in our lab is a standard policy and common practice. We discuss several challenges and our responses to those through the continuous evaluation of this adoption program. This paper explores the ethical imperative of rehoming all healthy animals of sentient species after experiments have finished or when they have become otherwise redundant. We take into account disparate perspectives in animal ethics and see how they point in the same direction. We illustrate our case with our own rehoming experience from the joint Animal Welfare Body of Utrecht University and the University Medical Centre Utrecht, the Netherlands. The primary pilot proved successful, after which the principle of rehoming became standing policy and common practice. We discuss several challenges and our responses to those through continuous evaluation of the adoption program. [ABSTRACT FROM AUTHOR]

Background: Given the developmental vulnerability of justice-involved youth, providing a safe environment in secure facilities is a paramount, yet challenging task. Within this complexity, a sound security framework is key. The security framework exists on three dimensions: physical, procedural and relational security. Existing knowledge points at the importance of a shift in focus on physical and procedural security towards relational security as the core of the security framework. At the same time there is a dearth of knowledge on relational security, particularly in the context of youth justice. This paper explores relational security and its working mechanisms in practice. Methods: This paper draws on findings of a comprehensive three-year evaluation of three small-scale, community-embedded facilities that are grounded in relational security. The approach of the evaluation was derived from action research, involving a cyclic process alternating between action, research and critical reflection, while engaging all stakeholders in the research process. The action research cycle involved qualitative research (a total of 63 semi-structured interviews) incorporating the perspective of staff, youth and parents. Results: Relational security is grounded in three distinct, but interrelated, elements – staff's basic attitude, a constructive alliance between staff and youth, staff presence – and promotes a safe and therapeutic environment through several mechanisms. Conclusions: Relational security can be defined in a practical conceptualization; outlining a way of working that guides staff in how to establish a safe and therapeutic environment in secure facilities. This conceptualization finds support in the well-established literature covering the therapeutic alliance and can be substantiated by two aligning theories concerning youth justice strategies: social-ecological theory and self-determination theory. Relational security is not only a way of working, but also a way of being. It encompasses a vision about security and mentality towards justice-involved youth that sees them not merely as 'risks to be managed', but primarly as 'resources to be developed'. [ABSTRACT FROM AUTHOR]

The article presents the authors' views in response to a comment on their paper "Patterns of Low and Lowest-Low Fertility in Europe," published in a 2004 issue of the journal "Population Studies." In their comment, the critics have argued that the cohort-fertility analysis in the aforesaid paper is weak on theoretical grounds and the empirical analysis is incomplete. The authors affirm that they agree with the comment that, as a society, the Netherlands differs from Southern Europe and even more from Central and Eastern Europe. Nevertheless, from a contemporary global perspective, these differences should not be overemphasized. They say that in their analyses, they used the Netherlands as a reference case of a country with an extraordinary pattern of late childbearing that is not associated with lowest-low fertility levels. However, the critics believe that these unusual characteristics invalidate the use of the Dutch example in the paper. So, this criticism is misconceived. It is precisely the unusualness of the fertility pattern in the Netherlands that makes it a useful reference point in the study of low and lowest-low fertility.

Introduction: Stroke care is complex and often provided by various healthcare organisations. Integrated care solutions are needed to optimise stroke care. In this paper, we describe the development of integrated stroke care in the region of Maastricht during the last 15 years. Description of integrated care case: Located in the south of the Netherlands, the region of Maastricht developed integrated stroke care to serve a population of about 180,000 people. Integration was needed to improve the continuity, coordination and quality of stroke care. The development of integrated care in Maastricht was a phased process. The last phase emphasized early discharge from hospital and assessing the best individual rehabilitation track in a specialized nursing home setting. Discussion and lessons learned: The development and implementation of integrated stroke care in the region of Maastricht led to fewer days in hospital, more patients being directly admitted to the stroke unit and an earlier start of rehabilitation. The implementation of early discharge from the hospital and rehabilitation assessment in a nursing home led to some unforeseen problems and lessons learned. [ABSTRACT FROM AUTHOR]

Following curative treatment for colorectal cancer (CRC), 30% to 50% of patients will develop recurrent disease. For CRC there are several lines of evidence supporting the hypothesis that early detection of metachronous disease offers a second opportunity for cure. This paper revisits the potential role of serum carcinoembryonic antigen (CEA) in follow-up. A comprehensive review of the literature (1978-2008) demonstrates that the initial promise of serum CEA as an effective surveillance tool has been tarnished through perpetuation of poorly designed studies. Specific limitations included: testing CEA as only an 'add-on' diagnostic tool; lack of standardization of threshold values; use of static thresholds; too low measurement frequency. Major changes in localizing imaging techniques and treatment of metastatic CRC further cause a decrease of clinical applicability of past trial outcomes. In 1982, Staab hypothesized that the optimal benefit of serum CEA as a surveillance tool is through high-frequency triage using a dynamic threshold (HiDT). Evidence supporting this hypothesis was found in the biochemical characteristics of serum CEA and retrospective studies showing the superior predictive value of a dynamic threshold. A multi-centred randomized phase III study optimizing the usage of HiDT against resectability of recurrent disease is commencing recruitment in the Netherlands. [ABSTRACT FROM AUTHOR]

The turbulent times governments all over the world are facing include the transition towards the Fourth Industrial Revolution (4IR) in which the confluence of new technological developments result in major challenges for national as well as local governments. The confluence of the newly developed technologies is only possible if huge amounts of data can be stored and transmitted at high speed in, among others, hyperscale data centers (HDCs). This paper focuses on the complex relation that arises between local governments - on whose soil the HDCs are built - and the high tech companies planning and building the HDCs. This relationship is characterized by an unequal playing field with local governments being no match for the high tech industry. The latter sometimes have annual turnovers 1000 times higher than those of local governments and impose rather different demands on decision making processes than governments do. They impose restrictions on the decision-making process that result in processes running counter to principles of good governance and, if exposed, result in a deterioration of institutional trust among the population. This is illustrated through a case study in which a small municipality in the Netherlands was faced with an offer from Meta to make a huge investment in a hyperscale data center, provided the whole process towards the permits and the approval of the building would remain secretive. Shown is an imposed secrecy by the high tech firm and information revealed about the process afterward through the Freedom of Information Act disclosing many irregularities. This changed the existing trust in the municipality into complete distrust at the end of the process and eventually forced the High Tech company to withdraw. The relevance of this paper for this special issue is that the case study shows that the new developments towards the 4IR require capacitated, knowledgeable and decisive local governments, which momentarily are not even present in a developed country like the Netherlands. [ABSTRACT FROM AUTHOR]

Surface solar irradiance varies on scales down to seconds, and detailed long-term observational datasets of this variable are rare but in high demand. Here, we present an observational dataset of global, direct, and diffuse solar irradiance sampled at 1 Hz as well as fully resolved variability until at least 0.1 Hz over a period of 10 years from the Baseline Surface Radiation Network (BSRN) station at Cabauw, the Netherlands. The dataset is complemented with irradiance variability classifications, clear-sky irradiance and aerosol reanalysis, information about the solar position, observations of clouds and sky type, and wind measurements up to 200 m above ground level. Statistics of variability derived from all time series include approximately 185 000 detected events of both cloud enhancement and cloud shadows. Additional observations from the Cabauw measurement site are freely available from the open-data platform of the Royal Netherlands Meteorological Institute. This paper describes the observational site, quality control, classification algorithm with validation, and the processing method of complementary products. Additionally, we discuss and showcase (potential) applications, including limitations due to sensor response time. These observations and derived statistics provide detailed information to aid research into how clouds and atmospheric composition influence solar irradiance variability as well as information to help validate models that are starting to resolve variability at higher fidelity. The main datasets are available at 10.5281/zenodo.7093164 and 10.5281/zenodo.7462362 ; the reader is referred to the "Code and data availability" section of this paper for the complete list. [ABSTRACT FROM AUTHOR]

For endangered species with limited dispersal capacity, the preservation of individual patches or sites is extremely important. The quality and size of habitat patches and their isolation from other patches are the main parameters for an assessment of population persistence, but translating persistence probabilities into practical measures is still a weak link in conservation management. I provide a quantitative conservation approach for the endangered myrmecophilous butterfly Maculinea alcon in the Netherlands. All 127 colonies known on heathland since 1990 were investigated for patch quality, size, and isolation. I assessed habitat quality in three 10 × 10 m plots for most colonies. Site occupancy in 1998–1999 was only 56%. Occupancy was best explained by a logistic regression including patch area, host ant presence, host plant abundance, overall heathland area, and connectivity between sites ( 2= 0.410, < 0.0001); it correctly classified the occupied or vacant status for 82% of the sites. Connectivity contributed only 3.6% to the total explained variation of site occupancy, indicating that habitat characteristics were more important than isolation in determining population persistence at the examined scale level (>500 m). Grazing and sod cutting had a beneficial impact, but in combination these practices proved detrimental. Hydrological measures to prevent drainage were also associated with lowered occupancy. I used the different components in the logistic regression to formulate objective management recommendations. These consisted of sod cutting, reduction of management intensity, enlargement of habitat, or combinations of these recommendations. The results highlight the importance of careful management when site quality is determined by multiple factors. The quantitative conservation approach followed here can be fruitfully extended to other endangered species, provided enough is known about their ecological requirements and how management actions affect them. [ABSTRACT FROM AUTHOR]

Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care. Plain Language Summary: This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy. [ABSTRACT FROM AUTHOR]

Human consumption of scarce ecological resources is at the heart of the climate change crisis. Mitigating climate change will require changes in consumer behavior. Further, to respond effectively, policymakers need information on the environmental impact of individuals' behaviors. In this paper, we study the effect of socio-demographic characteristics and personality traits on individuals' environmental impact measured by their ecological footprint. We also investigate consumers' willingness to pay for "green" goods. Using survey data from the Netherlands, first, we construct individuals' ecological footprint. The survey also uses a 50-item personality scale developed by Goldberg (1992) to construct five personality traits. We find that individuals with higher personal income, less than a high school education, males, the employed, and people living in rural areas are associated with a higher EF. We also find that consumers' WTP and demand are responsive to price increases in high-emitting goods and personality traits. We contribute to our understanding of the influence of socio-demographic and personality characteristics on the actual ecological footprint at the individual level. Further, we contribute to the economic literature on consumers' WTP for "green" products as well as the ongoing discussion on using market-based solutions to tackle climate change. [ABSTRACT FROM AUTHOR]

Pharmaceutical sector corruption undermines patient access to medicines by diverting public funds for private gain and exacerbating health inequities. This paper presents an analysis of UN Convention Against Corruption (UNCAC) compliance in seven countries and examines how full UNCAC adoption may reduce corruption risks within four key pharmaceutical decision-making points: product approval, formulary selection, procurement, and dispensing. Countries were selected based on their participation in the Medicines Transparency Alliance and the WHO Good Governance for Medicines Programme. Each country’s domestic anti-corruption laws and policies were catalogued and analysed to evaluate their implementation of select UNCAC Articles relevant to the pharmaceutical sector. Countries displayed high compliance with UNCAC provisions on procurement and the recognition of most public sector corruption offences. However, several countries do not penalise private sector bribery or provide statutory protection to whistleblowers or witnesses in corruption proceedings, suggesting that private sector pharmaceutical dispensing may be a decision-making point particularly vulnerable to corruption. Fully implementing the UNCAC is a meaningful first step that countries can take reduce pharmaceutical sector corruption. However, without broader commitment to cultures of transparency and institutional integrity, corruption legislation alone is likely insufficient to ensure long-term, sustainable pharmaceutical sector good governance. [ABSTRACT FROM AUTHOR]

Background: Before 2012, established national surveillance systems in the Netherlands were not able to provide a timely, comprehensive epidemiological view on nosocomial outbreaks. The Healthcare-associated Infections and AntiMicrobial Resistance Monitoring Group (SO-ZI/AMR) was initiated in 2012 for timely national nosocomial outbreak monitoring and risk assessment. This paper aims to describe the achievements of the SO-ZI/AMR by presenting characteristics of outbreaks reported in 2012–2021. Methods: Hospitals and, since 2015, long-term care facilities (LTCF) were requested to report outbreaks when (1) continuity of care was threatened, or (2) transmission continued despite control measures. A multi-disciplinary expert panel (re-)assessed the public health risk of outbreaks during monthly meetings, using 5 severity phases and based on data collected via standardised questionnaires. We descriptively studied the panel's consensus-based severity classification, distribution of (highly resistant) microorganisms, and duration and size of outbreaks between April 2012 and December 2021. Results: In total, 353 hospital outbreaks and 110 LTCF outbreaks were reported. Most outbreaks (hospitals: n = 309 (88%), LTCF: n = 103 (94%)) did not progress beyond phase 1 (no public health implications, outbreak expected to be controlled within two months), one hospital outbreak reached phase 4 (insufficient/ineffective response: possible public health threat, support offered). Highly resistant microorganisms (HRMO) were involved in 269 (76%) hospital and 103 (94%) LTCF outbreaks. Most outbreaks were caused by methicillin-resistant Staphylococcus aureus (MRSA; n = 93 (26%) in hospitals, n = 80 (72%) in LTCF), vancomycin-resistant Enterococcus faecium (VRE; n = 116 (33%) in hospitals, n = 2 (2%) in LTCF) and highly resistant Enterobacterales (n = 41 (12%) in hospitals, n = 20 (18%) in LTCF). Carbapenemase-producing gram-negative bacteria were involved in 32 (9.1%) hospital and five (4.5%) LTCF outbreaks. In hospitals, VRE outbreaks had the longest duration (median 2.3; range 0.0-22.8 months) and widest range of affected patients (median 9; range 2-483). Conclusions: The SO-ZI/AMR provided national insight into the characteristics of nosocomial outbreaks over the past decade. HRMO outbreaks – mostly caused by MRSA, VRE (in hospitals) and highly resistant Enterobacterales – occurred regularly, but most of them were controlled quickly and did not develop into a public health threat. The SO-ZI/AMR has become a solid monitoring body, essential to assess risks and raise awareness of potential HRMO threats. [ABSTRACT FROM AUTHOR]

Background: Despite the great confidence of Western governments in the principles of New Public Management (NPM) and its ability to stimulate "healthcare entrepreneurship", it is unclear how policies seeking to reform healthcare services provoke such entrepreneurship in individual institutions providing long-term healthcare. This study examines such situated responses in a Dutch nursing home for elderly people suffering from dementias such as Alzheimer's disease. Methods: A four-year inductive longitudinal single-case study has been conducted. During this time period, the Dutch government imposed various NPM-based healthcare reforms and this study examines how local responses unfolded in the nursing home. Through interviews conducted with managers, administrators and supporting staff, as well as the examination of a large volume of government instructions and internal documents, the paper documents how these reforms resulted in several types of entrepreneurship, which were not all conducive to the healthcare innovations the government aspired to have. Results: The study records three subsequent strategies deployed at the local level: elimination of healthcare services; non-healthcare related collaboration with neighboring institutions; and specialization in specific healthcare niches. These strategies were brought about by specific types of entrepreneurship – two of which were oriented towards the administrative organization rather than healthcare innovations. The study discusses the implications of having multiple variations of entrepreneurship at the local level. Conclusion: Governmental policies for healthcare reforms may be more effective, if policymakers change output-based funding systems in recognition of the limited control by providers of long-term healthcare over the progression of clients' mental disease and ultimate passing. [ABSTRACT FROM AUTHOR]

Background: Provision of paediatric palliative care for children with life-threatening or life-limiting conditions and their families is often complex. Guidelines can support professionals to deliver high quality care. Stakeholders expressed the need to update the first Dutch paediatric palliative care guideline with new scientific literature and new topics. This paper provides an overview of the methodology that is used for the revision of the Dutch paediatric palliative care guideline and a brief presentation of the identified evidence. Methods: The revised paediatric palliative care guideline was developed with a multidisciplinary guideline panel of 72 experts in paediatric palliative care and nine (bereaved) parents of children with life-threatening or life-limiting conditions. The guideline covered multiple topics related to (refractory) symptom treatment, advance care planning and shared-decision making, organisation of care, psychosocial care, and loss and bereavement. We established six main working groups that formulated 38 clinical questions for which we identified evidence by updating two existing systematic literature searches. The GRADE (CERQual) methodology was used for appraisal of evidence. Furthermore, we searched for additional literature such as existing guidelines and textbooks to deal with lack of evidence. Results: The two systematic literature searches yielded a total of 29 RCTs or systematic reviews of RCTs on paediatric palliative care interventions and 22 qualitative studies on barriers and facilitators of advance care planning and shared decision-making. We identified evidence for 14 out of 38 clinical questions. Furthermore, we were able to select additional literature (29 guidelines, two textbooks, and 10 systematic reviews) to deal with lack of evidence. Conclusions: The revised Dutch paediatric palliative care guideline addresses many topics. However, there is limited evidence to base recommendations upon. Our methodology will combine the existing evidence in scientific literature, additional literature, expert knowledge, and perspectives of patients and their families to provide recommendations. [ABSTRACT FROM AUTHOR]

Background: Unwarranted practice variation refers to regional differences in treatments that are not driven by patients' medical needs or preferences. Although it is the subject of numerous studies, most research focuses on variation at the end stage of treatment, i.e. the stage of the treating specialist, disregarding variation stemming from other sources (e.g. patient preferences, general practitioner referral patterns). In the present paper, we introduce a method that allows us to measure regional variation at different stages of the patient journey leading up to treatment. Methods: A series of logit regressions estimating the probability of (1) initial visit with the physician and (2) treatment correcting for patient needs and patient preferences. Calculating the coefficient of variation (CVU) at each stage of the patient journey. Results: Our findings show large regional variations in the probability of receiving an initial visit, The CVU, or the measure of dispersion, in the regional probability of an initial visit with a specialist was significantly larger (0.87–0.96) than at the point of treatment both conditional (0.14–0.25) and unconditional on an initial visit (0.65–0.74), suggesting that practice variation was present before the patient reached the specialist. Conclusions: We present a new approach to attribute practice variation to different stages in the patient journey. We demonstrate our method using the clinically-relevant segment of varicose veins treatments. Our findings demonstrate that irrespective of the gatekeeping role of general practitioners (GPs), a large share of practice variation in the treatment of varicose veins is attributable to regional variation in primary care referrals. Contrary to expectation, specialists' decisions meaningfully diminish rather than increase the amount of regional variation. [ABSTRACT FROM AUTHOR]

Countries have pledged to different national and international environmental agreements, most prominently the climate change mitigation targets of the Paris Agreement. Accounting for carbon stocks and flows (fluxes) is essential for countries that have recently adopted the United Nations System of Environmental-Economic Accounting - ecosystem accounting framework (UNSEEA) as a global statistical standard. In this paper, we analyze how spatial carbon fluxes can be used in support of the UNSEEA carbon accounts in five case countries with available in-situ data. Using global multi-date biomass map products and other remotely sensed data, we mapped the 2010–2018 carbon fluxes in Brazil, the Netherlands, the Philippines, Sweden and the USA using National Forest Inventory (NFI) and local biomass maps from airborne LiDAR as reference data. We identified areas that are unsupported by the reference data within environmental feature space (6–47% of vegetated country area); cross-validated an ensemble machine learning (RMSE=9–39 Mg C ha - 1 and R 2 =0.16–0.71) used to map carbon fluxes with prediction intervals; and assessed spatially correlated residuals (<5 km) before aggregating carbon fluxes from 1-ha pixels to UNSEEA forest classes. The resulting carbon accounting tables revealed the net carbon sequestration in natural broadleaved forests. Both in plantations and in other woody vegetation ecosystems, emissions exceeded sequestration. Overall, our estimates align with FAO-Forest Resource Assessment and national studies with the largest deviations in Brazil and USA. These two countries used highly clustered reference data, where clustering caused uncertainty given the need to extrapolate to under-sampled areas. We finally provide recommendations to mitigate the effect of under-sampling and to better account for the uncertainties once carbon stocks and flows need to be aggregated in relatively smaller countries. These actions are timely given the global initiatives that aim to upscale UNSEEA carbon accounting. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic new collaborative-care initiatives were developed for treating and monitoring COVID-19 patients with oxygen at home. Aim was to provide a structured overview focused on differences and similarities of initiatives of acute home-based management in the Netherlands. Methods: Initiatives were eligible for evaluation if (i) COVID-19 patients received oxygen treatment at home; (ii) patients received structured remote monitoring; (iii) it was not an 'early hospital discharge' program; (iv) at least one patient was included. Protocols were screened, and additional information was obtained from involved physicians. Design choices were categorised into: eligible patient group, organization medical care, remote monitoring, nursing care, and devices used. Results: Nine initiatives were screened for eligibility; five were included. Three initiatives included low-risk patients and two were designed specifically for frail patients. Emergency department (ED) visit for an initial diagnostic work-up and evaluation was mandatory in three initiatives before starting home management. Medical responsibility was either assigned to the general practitioner or hospital specialist, most often pulmonologist or internist. Pulse-oximetry was used in all initiatives, with additional monitoring of heart rate and respiratory rate in three initiatives. Remote monitoring staff's qualification and authority varied, and organization and logistics were covered by persons with various backgrounds. All initiatives offered remote monitoring via an application, two also offered a paper diary option. Conclusions: We observed differences in the organization of interprofessional collaboration for acute home management of hypoxemic COVID-19 patients. All initiatives used pulse-oximetry and an app for remote monitoring. Our overview may be of help to healthcare providers and organizations to set up and implement similar acute home management initiatives for critical episodes of COVID-19 (or other acute disorders) that would otherwise require hospital care. [ABSTRACT FROM AUTHOR]

In this paper, we introduce a method for automated seaweed growth monitoring by combining a low-cost RGB and stereo vision camera. While current vision-based seaweed growth monitoring techniques focus on laboratory measurements or above-ground seaweed, we investigate the feasibility of the underwater imaging of a vertical seaweed farm. We use deep learning-based image segmentation (DeeplabV3+) to determine the size of the seaweed in pixels from recorded RGB images. We convert this pixel size to meters squared by using the distance information from the stereo camera. We demonstrate the performance of our monitoring system using measurements in a seaweed farm in the River Scheldt estuary (in The Netherlands). Notwithstanding the poor visibility of the seaweed in the images, we are able to segment the seaweed with an intersection of the union (IoU) of 0.9, and we reach a repeatability of 6% and a precision of the seaweed size of 18%. [ABSTRACT FROM AUTHOR]

Objective: To investigate whether the use of the think-aloud method with propositional analysis could be helpful in the design of a Clinical Decision Support System (CDSS) providing guideline recommendations about long-term follow-up of childhood cancer survivors.Materials and Methods: The think-aloud method was used to gain insight into healthcare professionals' information processing while reviewing a paper-based guideline. A total of 13 healthcare professionals (6 physicians and 7 physician assistants) prepared 2 fictitious patient consults using the paper-based guideline. Propositional analysis was used to analyze verbal protocols of the think-aloud sessions. A prototype CDSS was developed and a usability study was performed, again with the think-aloud method.Results: The analysis revealed that the paper-based guideline did not support healthcare practitioners in finding patient-specific recommendations. An information processing model for retrieving recommendations was developed and used as input for the design of a CDSS prototype user interface. Usability analysis of the prototype CDSS showed that the navigational structure of the system fitted well with healthcare practitioners' daily practices.Conclusions: The think-aloud method combined with propositional analysis of healthcare practitioners' verbal utterances while they processed a paper-based guideline was useful in the design of a usable CDSS providing patient-specific guideline recommendations. [ABSTRACT FROM AUTHOR]