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This study examined the relation between both implementation fidelity and quality and the outcomes of two different anti-bullying interventions targeting distinct processes involved in bullying: moral disengagement and social norms. In total, 34 French-speaking Belgian teachers from six elementary schools were trained to deliver either the moral disengagement or the social norms intervention to their Grade 4-6 students (N = 747, 50.4% boys) in a randomized controlled trial. Students reported their moral disengagement, perceived injunctive class norm toward bullying, and bullying behaviors in the fall and spring of the 2018-2019 school year. Teachers' implementation fidelity and quality were assessed through direct observation in each class by two independent raters with a satisfying interrater reliability. A multiplicative moderated mediation model using latent change scores revealed that both greater fidelity and quality amplified students' decrease in moral disengagement, which was accompanied by a decrease in bullying. Importantly, when quality was sufficient, fidelity did not matter. However, higher fidelity could compensate for a lack of quality. Contrary to expectations, there was no significant change in students' perceptions of the class injunctive norm, even under ideal implementation conditions. Alternative mediators should thus be considered. Because implementation by teachers inevitably fluctuates, anti-bullying program components should be evaluated under various implementation conditions to determine their cost-effectiveness ratio and to gain insights into how anti-bullying programs work.

The transition to higher education has been extensively documented in the literature. In this line, many individual variables were identified as strong predictors of academic achievement. Yet, this literature suffers from one main limitation; contextual factors have often been left out of the investigation. The majority of studies have tested the impact of individual characteristics assuming that the effects are the same in different programs. However, differences between institutions or programs could result in specific learning contexts leading to different adjustment processes. As an attempt to overcome this limitation, the current study has investigated the impact of both individual and contextual factors on academic achievement through a multifactorial multilevel analysis. The analyses were carried out on 1,173 freshmen from 21 study programs. Results highlighted that 15% of variation in students' achievement was found between programs. Aspects of curriculum organization that contributed to academic achievement were gender ratio, opportunities given for practice and class size. Besides, seven individual factors were also predictive of academic achievement in the multifactorial approach: past performance, socioeconomic status, self-efficacy beliefs, value, mastery goal structure, study time and paid job. Finally, significant random effects were identified for peer support, course value, attendance and external engagement (i.e. commitment in extra-academic activities). The implications and limitations of this study are discussed. By connecting individual and contextual predictors of academic achievement this study intends to endorse a frontline approach regarding the transition to higher education.

This practice report discusses the evolution of a CS1 Course taught at the University of Liège, Belgium. Over the last seven years several teaching activities have been thought to complement traditional theoretical courses and exercise sessions in order to promote students' engagement. The result is aligned with (i) the principles of assessment for learning, which consists in leveraging the assessment to improve the students learning, and (ii) the concept of blended learning. This report describes the difficulties the students faced and what we implemented to assist our course evolution. We also present and discuss results showing that, despite a high drop-out rate, we managed to engage students to work on a regular basis and, in some cases, raise their performance levels.

There is currently much controversy surrounding the cognitive advantages that are often associated with bilingualism, especially regarding the so-called executive control advantage. Recently, it has been suggested that bilingualism emerging from immersion education may not lead to an advantage in executive control, but rather to an improvement specifically at the level of attentional abilities. In order to test this hypothesis, the current large sample study involving over 500 participants investigated whether foreign-language immersion education can be associated with an advantage in attentional functions. We recruited 12-year-old children and 18-year-old adolescents enrolled in immersion education in French-speaking Belgium for at least 6 years. They were compared to non-immersed children and adolescents on tasks assessing auditory sustained attention, auditory and visual selective attention and divided attention. Several control variables such as nonverbal intelligence, socioeconomic status and other potentially relevant background variables were also considered. The results indicate no measurable difference between the immersed and the non-immersed participants, for none of the examined attentional abilities. These findings are discussed in the light of the cognitive implications of becoming bilingual through a formal education experience.

This three-armed randomized controlled trial examined how moral disengagement and social norms account for change in bullying behavior and their potential as targets of anti-bullying components within separate interventions among 1200 French-speaking Belgian elementary students (48% boys, 9-12 year-olds, 57 classes, nine schools) during 2018-2019 (no ethnicity data available). Mediation analysis revealed that students' moral disengagement successfully decreased ([beta] = -0.46), which, in turn, reduced both bullying ([beta] = 0.33) and outsider behaviors ([beta] = 0.20), and increased defending ([beta] = -0.10). Intervening on social norms decreased bullying ([beta] = -0.18), but not through the perceived injunctive class norm as intended. Guidelines to open the "black box" of anti-bullying programs and determine the cost-effectiveness ratio of their components are provided.

This study investigates pupils' anxiety and enjoyment in the classroom when learning a second or foreign language. The particularity of this study lies in the comparison of two target languages (English and Dutch) in two educational contexts (CLIL and non-CLIL) at different instruction levels (primary and secondary education). While most research on content and language integrated learning (CLIL) focuses on English as a target language, the Belgian context calls for a comparison with the language of the "other" community, in this case Dutch. Data were collected from 896 pupils in French-speaking Belgium through a self-report questionnaire measuring pupils' anxiety and enjoyment in the classroom, along with background characteristics. Results indicate that while CLIL pupils experience significantly less anxiety than their non-CLIL counterparts, English learners report significantly less anxiety and more enjoyment than Dutch learners. This suggests an important role of the target language for emotional engagement in the classroom and calls for further investigation into the role of target language perceptions. Finally, the interactions with instruction level reveal that while primary school pupils report stronger emotions, the effects of CLIL and English are much larger at secondary level.

The purpose of this paper is to investigate how PBL student teams develop specific leadership configurations when implementing interdisciplinary projects and whether or not tutors help in dealing with the group interactions that are subsequently generated. The data set was drawn from 2 cohorts of first-year students engaged in PBL activities in an engineering school in Belgium in 2011 and 2012. Following qualitative content analysis of tutor and student feedback and the use of sociometric testing, findings for 2011 showed that students developed 4 specific leadership configurations, each of them being positively correlated to specific perceived work outcomes. Findings for 2012 were based on using the sociogram as a pedagogical tool to enable tutors to describe and regulate group dynamics. We found that tutors positively perceive their role in facilitating production outcomes but are more uncomfortable when it comes to regulating the interpersonal problems that arise in student self-managed teams.

Background: Nearly three out of four older people will use the emergency department (ED) during their last year of life. However, most of them do not benefit from palliative care. Providing palliative care is a real challenge for ED clinicians who are trained in acute, life-saving medicine. Our aim is to understand the ED's role in providing palliative care for this population. Methods: We designed a qualitative study based on 1) interviews – conducted with older patients (≥ 75 years) with a palliative profile and their informal caregivers – and 2) focus groups – conducted with ED and primary care nurses and physicians. Palliative profiles were defined by the Supportive and Palliative Indicators tool (SPICT). Qualitative data was collected in French-speaking Belgium between July 2021 and July 2022. We used a constant inductive and comparative analysis. Results: Five older patients with a palliative profile, four informal caregivers, 55 primary and ED caregivers participated in this study. A priori, the participants did not perceive any role for the ED in palliative care. In fact, there is widespread discomfort with caring for older patients and providing palliative care. This is explained by multiple areas of tensions. Palliative care is an approach fraught with pitfalls, i.e.: knowledge and know-how gaps, their implementation depends on patients'(co)morbidity profile and professional values, experiences and type of practice. In ED, there are constant tensions between emergency and palliative care requirements, i.e.: performance, clockwork and needs for standardised procedures versus relational care, time and diversity of palliative care projects. However, even though the ED's role in palliative care is not recognised at first sight, we highlighted four roles assumed by ED caregivers: 1) Investigator, 2) Objectifier, 3) Palliative care provider, and 4) Decision-maker on the intensity of care. A common perception among participants was that ED caregivers can assist in the early identification of patients with a palliative profile. Conclusions: Currently, there is widespread discomfort regarding ED caregivers caring for older patients and providing palliative care. Nonetheless, ED caregivers play four roles in palliative care for older patients. In the future, ED caregivers might also perform the role of early identifier. [ABSTRACT FROM AUTHOR]

Background: The mental health and well-being of GPs is a critical issue as they play a vital role in providing healthcare services to individuals and communities. Research has shown that GPs often face high levels of stress, burnout, and mental health problems due to their demanding work environment. During the COVID-19 pandemic, GPs faced additional challenges which further impacted their mental health and well-being. This study aims to investigate the impact of systemic work-related stressors on the level of well-being of GPs in Belgium during the pandemic, with a particular emphasis on identifying regional variations between Flanders, Wallonia, and Brussels-Capital. Methods: Data were collected with a self-reported online questionnaire from 479 GPs Belgian practices between December 2020 and August 2021 as part of the international PRICOV-19 study that explored the organization of general practices during COVID-19 in 38 countries to guarantee safe, effective, patient-centered, and equitable care. Well-being was evaluated by the Mayo Clinic's expanded 9-item well-being index. Results: The findings of this study reveal notable regional discrepancies in the degree of well-being experienced by Belgian GPs, with the Walloon region displaying the lowest level of well-being (37%) in a population highly susceptible to professional distress (57%). Among the key stressors contributing to such distress, financial difficulties among patients (p < 0.011), the fee-for-service payment system (p = 0.013), a lack of work-related purpose (p = 0.047), and inadequate work-life balance (p < 0.001) were identified as significant factors. When examining the influence of regional disparities, it was found that the sole significant interaction between work-related stressors and region regarding the probability of experiencing distress was related to the possibility of workload sharing among practice personnel. Conclusion: The findings from this study underscore the imperative for more comprehensive research aimed at scrutinizing the differences in well-being across the three regions in Belgium and identifying the systemic factors that influence the practice environment, as opposed to exclusively concentrating on enhancing individual resilience. [ABSTRACT FROM AUTHOR]

Background: General practitioners (GPs) have a vital role in reaching out to vulnerable populations during and after the COVID-19 pandemic. Nonetheless, they experience many challenges to fulfill this role. This study aimed to examine associations between practice characteristics, patient population characteristics and the extent of deprivation of practice area on the one hand, and the level of outreach work performed by primary care practices (PCPs) during the COVID-19 pandemic on the other hand. Methods: Belgian data from the international PRICOV-19 study were analyzed. Data were collected between December 2020 and August 2021 using an online survey in PCPs. Practices were recruited through randomized and convenience sampling. Descriptive statistics and ordinal logistic regression analyses were performed. Four survey questions related to outreach work constitute the outcome variable. The adjusted models included four practice characteristics (practice type, being a teaching practice for GP trainees; the presence of a nurse or a nurse assistant and the presence of a social worker or health promotor), two patient population characteristics (social vulnerability and medical complexity) and an area deprivation index. Results: Data from 462 respondents were included. First, the factors significantly associated with outreach work in PCPs are the type of PCP (with GPs working in a group performing more outreach work), and the presence of a nurse (assistant), social worker or health promotor. Second, the extent of outreach work done by a PCP is significantly associated with the social vulnerability of the practice's patient population. This social vulnerability factor, affecting outreach work, differed with the level of medical complexity of the practice's patient population and with the level of deprivation of the municipality where the practice is situated. Conclusions: In this study, outreach work in PCPs during the COVID-19 pandemic is facilitated by the group-type cooperation of GPs and by the support of at least one staff member of the disciplines of nursing, social work, or health promotion. These findings suggest that improving the effectiveness of outreach efforts in PCPs requires addressing organizational factors at the practice level. This applies in particular to PCPs having a more socially vulnerable patient population. [ABSTRACT FROM AUTHOR]

Real-time PCRs were developed to characterize Fomes fomentarius lineages occurring in the beech forests of the Ardennes (southern Belgium). A collection of F. fomentarius sensu lato isolates was built up in 2020 and 2021 from basidiocarps developing on beech trunks, stumps, or logs. Two of the 148 isolates tested (monokaryotic and dikaryotic) belonged to the species Fomes inzengae, while the other isolates corresponded to the species Fomes fomentarius sensu stricto. As far as we know, this is the first record of Fomes inzengae in Belgium. This fungus was also found in a mature tree not showing any signs of decay. This demonstrates its endophytic nature. Growth tests at different temperatures, as well as wood degradation tests in accordance with standard NBN EN113 showed different behavior between both species. Passive sticky traps were installed during two growing seasons at the two sites where F. inzengae had been reported. Spores were detected at all collection times between April and July, using the specific molecular test developed. Moreover, in 2023, the DNA concentrations measured were 100 times higher than in 2022. The implications of this new species in Belgium is discussed in the context of climate change. [ABSTRACT FROM AUTHOR]

Research on the electoral personalization of politics has stressed a trend towards a greater role of top prominent political figures (party leaders and ministers). This trend was described as centralized electoral personalization. Yet, this trend is merely one side of a more complex story. No leader attracts all voters' support, and other candidates manage to stand out despite lower resources and visibility. Using a unique dataset of 47,239 actual ballot papers cast for the 2018 Belgian local elections, we show that candidate-level, list-level and district-level factors result in distinct preference voting behaviour. While these factors lead to unmistakable forms of (de-)centralized personalized forms of elections, we furthermore, show that intermediary situations distinctively emerge. A significant number of 'subtop' candidates stand out among candidates, by attracting support from voters who do not support the mere leader of the list. This 'oligarchized personalization' would deserve greater attention in the literature. [ABSTRACT FROM AUTHOR]

Research has shown that politicians' perceptions of public opinion are subject to social projection. When estimating the opinions of voters on a broad range of issues, politicians tend to assume that their own preferences are shared by voters. This article revisits this finding and adds to the literature in three ways. First, it makes a conceptual contribution by bringing together different approaches to the analysis of projection and its consequences. Second, relying on data from surveys with politicians (n = 866) in four countries (Belgium, Canada, Germany, and Switzerland) conducted between March 2018 and September 2019, it shows that there is more projection in politicians' estimations of their partisan electorate than in their estimations of the general public or of their geographic district. Third, comparing the data on politician projection with data from parallel surveys with citizens, the article reveals that—at least in three out of the four countries studied here—elected politicians are not better at avoiding erroneous projection than ordinary citizens. The article discusses the implications of these findings for the workings of representative democracy. [ABSTRACT FROM AUTHOR]

Most students enter their first university physics course with a system of beliefs and intuitions which are often inconsistent with the Newtonian frame of reference. This article presents an experiment of collaborative learning aiming at helping first-year students in an engineering programme to transition from their naïve intuition about dynamics to the Newtonian way of thinking. In a first activity, students were asked to critically analyse the contents of two video clips from the point of view of Newtonian mechanics. In a second activity, students had to design and realise their own video clip to illustrate a given aspect of Newtonian mechanics. The preparation of the scenario for the second activity required looking up and assimilating scientific knowledge. The efficiency of the activity was assessed on an enhanced version of the statistical analysis method proposed by Hestenes and Halloun, which relies on a pre-test and a post-test to measure individual learning.

Introduction: The present study aimed to test a theoretically-based model (the self-system model of motivational development) including at the same time the extent to which the social context provides structure, warmth and autonomy support, the students' perceived autonomy, relatedness and competence, and behavioral, cognitive and emotional student engagement. Method: Three hundred and thirty one participants attending the last year at the university completed a self-reported questionnaire tapping the targeted variables. SEM analyses were used to test our hypotheses. Results: Results revealed that each dimension of the social context was associated with the corresponding self-perception variables which, in turn, predicted greater behavioral, cognitive and emotional engagement. Cognitive engagement was directly predicted by the three self-perception variables, and indirectly by an autonomy supportive social context. Structured social context was indirectly associated, through perceived competence, with behavioral and emotional engagement. Discussion and Conclusion: Two underlying assumptions of the SSMMD (and more broadly of the SDT) were supported by the results of this study - the three dimensions of social context have specific effects on self-perception variables and these perceptions are mediators of the relationship between context and student engagement - one was not - the three self-perception variables do not have a direct impact on the dimensions of student engagement.

Purpose: To evaluate the effects of a 6-week taekwondo-specific high-intensity interval training (HIIT) in simulated normobaric hypoxia on physical fitness and performance in taekwondoists. Methods: Eighteen male and female black-belt taekwondoists trained twice a week for 6 weeks in normoxia or in hypoxia (FiO2 = 0.143 O2). The HIIT was composed of specific taekwondo movements and simulated fights. Body composition analyses and a frequency speed of kick test during 10 seconds (FSKT10s) and 5 × 10 seconds (FSKTmult), countermovement jump (CMJ) test, Wingate test, and an incremental treadmill test were performed before and after training. Blood lactate concentrations were measured after the FSKTmult and Wingate tests, and a fatigue index during the tests was calculated. Results: A training effect was found for FSKT10s (+35%, P <.001), FSKTmult (+32%, P <.001), and fatigue index (−48%, P =.002). A training effect was found for CMJ height (+5%, P =.003) during the CMJ test. After training, CMJ height increased in hypoxia only (+7%, P =.005). No effect was found for the parameters measured during Wingate test. For the incremental treadmill test, a training effect was found for peak oxygen consumption (P =.002), the latter being 10% lower after than before training in normoxia only (P =.002). Conclusions: In black-belt taekwondoists, hypoxic HIIT twice a week for 6 weeks provides tiny additional gains on key performance parameters compared with normoxic HIIT. Whether the trivial effects reported here might be of physiological relevance to improve performance remains debatable and should be tested individually. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the direction of the effect between goal orientation, self-regulation and deep processing strategies in order to understand the impact of these three constructs on students' achievement. The participants were 110 freshmen from the engineering faculty at the Universite catholique de Louvain in Belgium, who were followed during the first three years of their university studies. Data were analyzed through structural equation modeling. The main finding was that mastery goal orientation increased students' subsequent deep processing which in turn enhanced subsequent self-regulation. Deep processing and self-regulation also appeared to be mutually influential from year 2 to year 3. The implications of our results for the understanding of the interplay between cognitive and motivational processes in higher education are discussed. (Contains 5 tables and 4 figures.)

Objectives In August 2018, a public health alert was issued in Belgium regarding clusters of impetigo cases caused by the epidemic European fusidic acid-resistant impetigo clone (EEFIC) of Staphylococcus aureus. As a result, the Belgian national reference centre (NRC) was commissioned to update the epidemiology of S. aureus causing community-onset skin and soft tissues infection (CO-SSTI) to assess the proportion of EEFIC among them. Methods For 1 year, Belgian clinical laboratories were asked to send their first three S. aureus isolated from CO-SSTI each month. Isolates were tested for antimicrobial susceptibility to oxacillin, mupirocin and fusidic acid. Resistant isolates were also spa typed and tested for the presence of the genes encoding the Panton–Valentine leucocidin, the toxic shock syndrome toxin and the exfoliatins A and B. MLST clonal complexes were deduced from the spa types. Results Among the 518 S. aureus strains analysed, 487 (94.0%) were susceptible to oxacillin. Of these, 79 (16.2%) were resistant to fusidic acid, of which 38 (48.1%) belonged to the EEFIC. EEFIC isolates were mostly isolated from young patients with impetigo and showed a seasonal late summer peak. Conclusions These results suggest the persistence of EEFIC in Belgium. Furthermore, its prevalence may lead to reconsideration of the treatment guidelines for impetigo. [ABSTRACT FROM AUTHOR]

Objective of specifically evaluating the involvement of users in monitoring surveys, this study evaluated the surveys according to the following parameters: content of a study based on themes presented in surveys; inclusion of health literacy (HL); and factors of commitment of the respondents to the survey.Results: A total of 45 studies were selected for final analysis. The majority of the surveys focused on the effect of COVID-19 on well-being. Furthermore, analysis indicated that, in summary, the HL of people concerned as well as the involvement of respondents is poorly considered, which remains limited in terms of the design and administration of the surveys.Discussion: Although the principles of health democracy seemed to have been established, the exceptional regime induced by the epidemic overlooked the observance of such principles. This result indicates the need to reconsider the participation of citizens as real partners in care, including health crisis management. [ABSTRACT FROM AUTHOR]

Summary: Our imminent model was less sensitive but more selective than FRAX® in the choice of treatment to prevent imminent fractures. This new model decreased NNT by 30%, which could reduce the treatment costs. In the Belgian FRISBEE cohort, the effect of recency further decreased the selectivity of FRAX®. Purpose: We analyzed the selection for treatment of patients at high risk of fracture by the Belgian FRISBEE imminent model and the FRAX® tool. Methods: We identified in the FRISBEE cohort subjects who sustained an incident MOF (mean age 76.5 ± 6.8 years). We calculated their estimated 10-year risk of fracture using FRAX® before and after adjustment for recency and the 2-year probability of fracture using the FRISBEE model. Results: After 6.8 years of follow-up, we validated 480 incident and 54 imminent MOFs. Of the subjects who had an imminent fracture, 94.0% had a fracture risk estimated above 20% by the FRAX® before correction for recency and 98.1% after adjustment, with a specificity of 20.2% and 5.9%, respectively. The sensitivity and specificity of the FRISBEE model at 2 years were 72.2% and 55.4%, respectively, for a threshold of 10%. For these thresholds, 47.3% of the patients were identified at high risk in both models before the correction, and 17.2% of them had an imminent MOF. The adjustment for recency did not change this selection. Before the correction, 34.2% of patients were selected for treatment by FRAX® only, and 18.8% would have had an imminent MOF. This percentage increased to 47% after the adjustment for recency, but only 6% of those would suffer a MOF within 2 years. Conclusion: In our Belgian FRISBEE cohort, the imminent model was less sensitive but more selective in the selection of subjects in whom an imminent fracture should be prevented, resulting in a lower NNT. The correction for recency in this elderly population further decreased the selectivity of FRAX®. These data should be validated in additional cohorts before using them in everyday practice. [ABSTRACT FROM AUTHOR]

A growing body of research indicates that transformational leadership affects teachers' commitment to their school. The present study aims to investigate the processes explaining this effect at the organisational level. Using a sample of 660 teachers within 50 primary French-speaking Belgian schools, the authors test a model hypothesising that the impact of the school principal's transformational leadership (as an organisational-level construct) on teacher commitment to school is mediated by school culture strength (cognitive pathway) and teacher collective efficacy beliefs (motivational pathway). Results of multilevel analyses largely support the theoretical model, but show that schools have a limited impact on teacher commitment. (Contains 5 tables and 1 figure.)

This exploratory study aimed to investigate elements involved in decision making in team handball live situations and to provide coaches and educators with teaching recommendations. The study was positioned within the framework of the situated-action paradigm of which two aspects were of particular interest for this project: (a) the relationship between planning and action, and (b) the perception-action coordination. We used qualitative methods that linked (a) video observation of six female elite players' actions during two championship matches and (b) self-confrontation interviews. Players' verbalizations reflected that their decision making included the following: (a) perception (visual, auditory, tactile, proprioceptive), (b) knowledge (concepts, teammates and opponents' characteristics, experience), (c) expectations (opponents and teammates' intentions), and (d) contextual elements (score, power play, players on the field, match difficulty). Findings were discussed in terms of teaching implications. (Contains 4 tables.)

This paper reports results from two studies aimed at examining whether perception of social acceptance and actual social acceptance differ according to the presence of an illusion of scholastic incompetence. Results of both studies conducted in Belgium and in Quebec (respectively 179 and 543 participants) show that children's illusion of scholastic incompetence is linked to a negative perception of social acceptance. However, according to the evaluation by peers, social acceptance of those children is similar to the others. This suggests a generalization of the negative bias of self-evaluation to both academic and social domains. The discussion proposes further variables that could improve the understanding of the origin of the illusion of incompetence. (Contains 4 tables.)

Background: Stillbirth has been recognized as a possible complication of a SARS-CoV-2 infection during pregnancy, probably due to destructive placental lesions (SARS-CoV-2 placentitis). The aim of this work is to analyse stillbirth and late miscarriage cases in unvaccinated pregnant women infected with SARS-CoV-2 during the first two waves (wild-type period) in Belgium. Methods: Stillbirths and late miscarriages in our prospective observational nationwide registry of SARS-CoV-2 infected pregnant women (n = 982) were classified by three authors using a modified WHO-UMC classification system for standardized case causality assessment. Results: Our cohort included 982 hospitalised pregnant women infected with SARS-CoV-2, with 23 fetal demises (10 late miscarriages from 12 to 22 weeks of gestational age and 13 stillbirths). The stillbirth rate was 9.5‰ for singleton pregnancies and 83.3‰ for multiple pregnancies, which seems higher than for the background population (respectively 5.6‰ and 13.8‰). The agreement between assessors about the causal relationship with SARS-Cov-2 infection was fair (global weighted kappa value of 0.66). Among these demises, 17.4% (4/23) were "certainly" attributable to SARS-CoV-2 infection, 13.0% (3/23) "probably" and 30.4% (7/23) "possibly". Better agreement in the rating was noticed when pathological examination of the placenta and identification of the virus were available, underlining the importance of a thorough investigation in case of intra-uterine fetal demise. Conclusions: SARS-CoV-2 causality assessment of late miscarriage and stillbirth cases in our Belgian nationwide case series has shown that half of the fetal losses could be attributable to SARS-CoV-2. We must consider in future epidemic emergencies to rigorously investigate cases of intra-uterine fetal demise and to store placental tissue and other material for future analyses. [ABSTRACT FROM AUTHOR]

Introduction: Recently, the literature has promoted the use of patient‐reported outcome measures (PROMs) in clinical practice as a means to foster patient engagement. However, conditions necessary to support the use of PROMs to encourage asthma patient engagement are not clearly defined. Therefore, we sought (1) to explore the current and ideal use of PROMs by healthcare professionals (HP) in specialized asthma management centers in French‐speaking Belgium and (2) to understand under which conditions the use of PROMs contributes to patient engagement. Methods: We undertook a mixed‐methods study with both anonymous online survey and in‐person qualitative semi‐structured interviews conducted with HPs to understand their perspectives on the routine use of PROMs. HPs were recruited from 16 asthma centers (French‐speaking Belgium) identified via the Belgian Respiratory Society. Results: Of the 170 HPs identified from the 16 participating centers, 51 (30%) responded to the survey (n = 51) and 11 completed semi‐structured interviews. 53% (27/51) of the surveyed HPs reported using PROMs primarily for asthma monitoring and clinical research while all reported that PROMs should primarily be used in practice to facilitate communication with the patient and to address neglected aspects of the care relationship such as the psychosocial aspects of the disease. The qualitative interviews revealed avenues for moving from a medical‐centered and utilitarian use of PROMs to a use serving patient engagement. This would require HPs to go beyond their current representation of PROMs, to use instruments offering a more holistic image of the patient, to incorporate PROMs into a digital tool and to integrate PROMs in a patient education process. Conclusion: The main findings of this study suggest relevant avenues for using PROMs in ways that support patient engagement. [ABSTRACT FROM AUTHOR]

Background and Objectives: Antiplatelet therapy, when prescribed in combination with anticoagulant therapy to older patients with atrial fibrillation and no recent cardiovascular event, is inappropriate and a reversible risk factor of major bleeding. We aimed to assess the trend over time of the prevalence of inappropriate combined antiplatelet and anticoagulant therapy and to determine its associated factors during the direct oral anticoagulant era. Methods: This was a study of consecutive older patients (age ≥ 75 years) with atrial fibrillation, receiving anticoagulant therapy upon admission, and undergoing a comprehensive geriatric assessment during their first admission in a Belgian teaching hospital between 2009 and 2018. Antiplatelet therapy was considered inappropriate in the absence of a recent cardiovascular event. We studied the prevalence of inappropriate combined antiplatelet and anticoagulant therapy by 2-year periods and assessed its associated factors since the year 2013. Results: Inappropriate combined antiplatelet and anticoagulant therapy was identified in 21% of the 654 patients (median age 84 years, 51% women), with a prevalence decreasing (p ≤ 0.01) from 25% (2009–10) to 14.8% (2017–18). Among the 469 patients recruited during the direct oral anticoagulant era, inappropriate combined antiplatelet and anticoagulant therapy (19%) was associated in a multivariable analysis with a history of stroke/transient ischemic attack (odds ratio 2.13, p = 0.007), anticoagulation with low-molecular-weight heparin (odds ratio 3.44, p = 0.015), and a history of vascular disease (odds ratio 5.68, p < 0.001). Conclusions: While inappropriate combined antiplatelet and anticoagulant therapy has declined over the last decade, there is still room for improvement. Antiplatelet deprescribing should be considered in all patients with inappropriate combined antiplatelet and anticoagulant therapy, including those with vascular disease and no recent cardiovascular event. [ABSTRACT FROM AUTHOR]

Rapid Whole Genome Sequencing (rWGS) represents a valuable exploration in critically ill pediatric patients. Early diagnosis allows care to be adjusted. We evaluated the feasibility, turnaround time (TAT), yield, and utility of rWGS in Belgium. Twenty-one unrelated critically ill patients were recruited from the neonatal intensive care units, the pediatric intensive care unit, and the neuropediatric unit, and offered rWGS as a first tier test. Libraries were prepared in the laboratory of human genetics of the University of Liège using Illumina DNA PCR-free protocol. Sequencing was performed on a NovaSeq 6000 in trio for 19 and in duo for two probands. The TAT was calculated from the sample reception to the validation of results. Clinical utility data were provided by treating physicians. A definite diagnosis was reached in twelve (57.5%) patients in 39.80 h on average (range: 37.05–43.7). An unsuspected diagnosis was identified in seven patients. rWGS guided care adjustments in diagnosed patients, including a gene therapy, an off-label drug trial and two condition-specific treatments. We successfully implemented the fastest rWGS platform in Europe and obtained one of the highest rWGS yields. This study establishes the path for a nationwide semi-centered rWGS network in Belgium. [ABSTRACT FROM AUTHOR]

Research misconduct is a global concern. Considerable research has been devoted to guidance documents, but little attention has been paid to the empirical investigation of how (alleged) cases of research misconduct are addressed in real-life and which criteria are used to qualify a case as misconduct. Therefore, we performed a content analysis of 169 closed misconduct reports between 2007 and 2017 from Denmark, the Netherlands and Belgium, representing three different types of governance of research misconduct. This study showed that when considering a case of (alleged) misconduct investigating committees assess 1) the objective evidence of research misconduct, 2) the subjective intent of the person subject to investigations, and 3) case specific circumstances. We found that research misconduct was established in 15% (9/61) of cases in Denmark; 16% (13/82) in the Netherlands and 38% (10/26) in Belgium. 57% (35/61) of cases in Denmark, 49% (40/82) in the Netherlands, and 12% (3/26) in Belgium were deemed outside of the scope of the investigating committee. Our analysis improves the understanding of how investigations of (alleged) misconduct are handled by the investigating committees in Europe. [ABSTRACT FROM AUTHOR]

Objective: Improved treatment landscape has led to better outcomes for paediatric acute lymphoblastic leukemia (ALL) survivors. As the number of survivors increase, we need to elucidate the long‐term quality of life (QoL) and domains of complaints in these patients. Furthermore, the main priorities of these patients need to be clarified. We assessed long‐term QoL outcomes of survivors of childhood ALL compared to matched population controls. Methods: QoL data were collected from survivors recruited in France and Belgium between 2012 and 2017, including the Short Form Health Survey (SF‐12) and the Quality of Life Systemic Inventory (QLSI). The Wilcoxon test was used to compare SF‐12 scale scores between survivors and matched population controls. For the QLSI, comparisons were mainly descriptive. Results: One hundred and eighty‐six survivors (mean age: 27.6 years; range: 18.1–52.8) at follow‐up completed QoL measures, amongst whom 180 were matched to controls. Overall, survivors had higher QoL on all SF12 scale scores, indicating that they had better functioning compared to controls. Statistically significant differences on the SF12 were observed for Vitality, Social Functioning, Role Limitations due to Emotional Problems and Mental Health scales. QLSI outcomes suggested that survivors were happier than controls with Couple and Social Relations. Controls were unhappiest compared to survivors with Money, Love life, Self‐esteem, Nutrition and Paid Work. Conclusions: Our findings suggest that survivors of childhood ALL have better QoL outcomes on some domains compared to the general population, specifically around social and emotional functioning, and that they tend to prioritize their relationships more. Interventions for improving QoL outcomes, might build on existing positive experiences with family, friends and partners. [ABSTRACT FROM AUTHOR]

Background: Despite therapeutic progress, 10 to 30% of adult patients with primary mediastinal B cell lymphoma (PMBCL) are primary refractory or experience early relapse (R/R). Allogeneic stem cell transplantation (allo-HSCT) thus remains a potentially curative option in this setting. Material and Methods: In this multicenter retrospective study, the outcomes of 33 French and Belgian adult patients allo-transplanted for R/R PMBCL between January 1999 and December 2018, were examined. Results: At allo-HSCT time, patients had received a median of 3 treatment lines, 50% of them were in complete response, 40% in partial response and 10% had a progressive disease. Forty-two percent of the donors were siblings and 39% matched related. The median follow-up for alive patients was 78 months (3.5–157). Considering the whole cohort, 2-year overall survival (OS), progression free survival (PFS) and graft-versus-host disease-free/relapse-free survival (GRFS) were 48% (95%CI: 33–70), 47% (95%CI: 33–68) and 38.5% (95%CI: 25–60) respectively. Cumulative incidence of relapse and non-relapse mortality rates were respectively 34% (95%CI: 18–50) and 18% (95%CI: 7–34). Disease status at transplant was the only factor predicting survivals, patients with progressive disease showing significant lower 2-year PFS (HR: 6.12, 95%CI: 1.32–28.31, p = 0.02) and OS (HR: 7.04, 95%CI: 1.52–32.75, p = 0.013). A plateau was observed for OS and PFS after 4 years with 10 patients alive after this date, suggesting that almost one third of the patients effectively salvaged and undergoing allo-SCT could be cured. Conclusion: This study indicates that allo-HSCT is a valid therapeutic option for R/R PMBCL, providing durable remissions. [ABSTRACT FROM AUTHOR]

Schools have been a point of attention during the pandemic, and their closure one of the mitigating measures taken. A better understanding of the dynamics of the transmission of SARS-CoV-2 in elementary education is essential to advise decisionmakers. We conducted an uncontrolled non-interventional prospective study in Belgian French-speaking schools to describe the role of attending asymptomatic children and school staff in the spread of COVID-19 and to estimate the transmission to others. Each participant from selected schools was tested for SARS-CoV-2 using a polymerase chain reaction (PCR) analysis on saliva sample, on a weekly basis, during six consecutive visits. In accordance with recommendations in force at the time, symptomatic individuals were excluded from school, but per the study protocol, being that participants were blinded to PCR results, asymptomatic participants were maintained at school. Among 11 selected schools, 932 pupils and 242 school staff were included between January and May 2021. Overall, 6449 saliva samples were collected, of which 44 came back positive. Most positive samples came from isolated cases. We observed that asymptomatic positive children remaining at school did not lead to increasing numbers of cases or clusters. However, we conducted our study during a period of low prevalence in Belgium. It would be interesting to conduct the same analysis during a high prevalence period. [ABSTRACT FROM AUTHOR]

Aims: The goal of this study was to gain insight into the views and experiences of an intensive care team working in a new nursing‐care delivery model during the COVID‐19 waves. A new model of care was implemented to augment nursing capacity and provide sufficient intensive care beds. Design: A qualitative monocentric study using rapid qualitative descriptive methods was reported in line with the COREQ checklist. Methods: Nurse, ward manager and physician participants were purposively recruited between January and March 2021 in a tertiary university‐affiliated hospital in the Flemish‐speaking part of Belgium. Semistructured interviews were conducted and analysed using thematic analysis methods. Results: The participants were seventeen expert nurses, twelve supporting nurses, seven ward managers and four physicians. A central theme of ensuring safe, high‐quality care emerged from the findings. There was a sense of losing one's grip on clinical practice when working in the mixed nursing‐care teams. Different underlying experiences played a part in this sense of losing control: dealing with unknown elements, experiencing role ambiguity, struggling with responsibility and the absence of trust. Several coping mechanisms were developed by the nursing‐care team to deal with those experiences, including attempts to create stability, to strike a balance between delegating and educating, to build in control and to communicate openly. Conclusion: In this rapid qualitative descriptive study, the implementation of a new nursing‐care delivery model during a pandemic was seen to lead to several challenges for all members of the care team. Coping mechanisms were developed by the team to deal with these experienced challenges. Impact When rethinking nursing‐care delivery models, the findings of this study may help guide the process of implementing mixed nursing‐care teams. Special attention needs to be paid to clarifying roles, sharing responsibility and clinical leadership. Other significant influences (such as moral distress) should also be taken into account. [ABSTRACT FROM AUTHOR]

While many studies have documented the intentions for the COVID-19 vaccine booster, few have explored the change from intention to final decision. This study explores the COVID-19 booster intentions and the change from intention to decision in a primo-vaccinated university population, with a distinction between staff members and students. It looks at the sociodemographic and medical characteristics, health literacy, personal COVID-19 infection and vaccination history, and attitudes/intentions regarding the booster, among the 1030 participants (64.4% staff members, 61.3% female, median age 36.0 years). Of the 8.7% who were initially hesitant, 72.7% ultimately got a booster and 27.3% did not. Another 84.2% intended to get a booster and 7.1% did not. Among the latter two groups, 88.9% maintained their intention and 11.1% changed their minds. The determinants associated with the intentions were health literacy and previous intentions regarding the COVID-19 primo-vaccination. The determinants associated with the change to non-vaccination were a previous COVID-19 infection, a past COVID-19 primo-vaccination intention, and a neutralizing antibody level. The results point to an opening for the support in decision-making, with a significant percentage of the study population potentially changing their mind between intention and final decision; this process should start early and be tailored to the individual's COVID-19 history. A personalized approach seems necessary in order to ensure that individuals make an informed choice. [ABSTRACT FROM AUTHOR]

Current public health debate centers on COVID-19 testing methods and strategies. In some communities, high transmission risk may justify routine testing, and this requires test methods that are safe and efficient for both patients and the administrative or health-care workers administering them. Saliva testing appears to satisfy those criteria. There is, however, little documentation on the acceptability of this method among beneficiaries. This article presents the lessons learned from a pilot study on the use of saliva testing for routine screening of nursing home and secondary school personnel in Wallonia (the French-speaking part of Belgium), conducted in December 2020 to April 2021, respectively. Administrators at the facilities in question seemed to think highly of saliva testing and wished to continue it after the pilot study was over. This result reinforces the criteria (the noninvasive aspect, in particular) supporting a key role for saliva testing in monitoring community spread of the virus. Nevertheless, wider-scale deployment of this particular method will only be possible if the testing strategy as a whole takes a health promotion approach. [ABSTRACT FROM AUTHOR]

The article discusses a study which compared the performance of double-trunk mask (DTM) and non-rebreather mask (NRM) on arterial blood gases in hypoxemic subjects with COVID-19 presenting to emergency department (ED) with acute respiratory distress. Topics covered include the inclusion criterion and sociodemographic description of study participants, the improvement in blood oxygenation with DTM compared to NRM, and the strengths and limitations of the study.

Only a few recent phase III trials with targeted therapies or immune checkpoint inhibitors (ICIs) in metastatic clear-cell renal cell carcinoma (m-ccRCC) demonstrated an overall survival (OS) benefit compared to standard of care. We aimed to study the evolution of OS since the start of systemic therapy from 2000 to 2020. Retrospective study on all consecutively treated m-ccRCC patients in three Belgian hospitals starting with systemic therapy. The study outcome was OS since the start of systemic therapy. We used a univariable Cox model for OS with year of the start of therapy as a predictor, and a multivariable analysis including known prognostic factors. Linear and non-linear trends of time were tested. Five hundred patients were included. In a linear model, the HR for OS depending on the year of the start of therapy was 0.95 (95%CI 0.93–0.97; p < 0.0001), estimated for an increase with 1 year in time. In a non-linear model, OS started to improve from 2006 on, when vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs) replaced interferon alfa (IFNa) as a standard of care and continued to increase steadily during the following years. On multivariable analysis, the year of the start of therapy remained an independent prognostic factor for OS. Two-year OS after the start of systemic therapy was 23%, 34%, 50% and 59% for patients who started treatment in 2000–2005, 2006–2011, 2012–2017, and 2018–2020, respectively. The five-year OS of the first three groups was 7%, 14% and 24%. The mean number of administered lines of therapy increased over time, with an incidence rate ratio of 1.07 (95%CI 1.05–1.08; p < 0.0001) per year increase for the period 2000–2016. OS of m-ccRCC patients has been improving significantly over the last 15 years since the introduction of VEGFR-TKIs and ICIs. [ABSTRACT FROM AUTHOR]

This article studies citizens' support for deliberative democracy in Belgium. It examines it, first, from the perspective of Belgian citizens in general. In a second step, it looks specifically at the attitudes of citizens from four disadvantaged groups (women, lower educated citizens, citizens with precarious job conditions and younger citizens). Regarding these groups we want to see whether they show different levels of support for deliberative democracy than the rest of the population and if their attitudes are driven by the same factors as for citizens from more advantaged groups. Regarding the general population, the main finding is that support for deliberative democracy is driven by negative attitudes towards elected politicians but mainly by positive attitudes regarding the political competence of fellow citizens. Regarding disadvantaged groups, we see first that women and younger citizens show higher levels of support than the rest of the population. Second, when it comes to the factors driving support for deliberative democracy within these disadvantaged groups, it appears that they are similar to the rest of the population except when it comes to political interest. Being more interested in politics is a determinant to be in favour of deliberative democracy for citizens from disadvantaged groups. [ABSTRACT FROM AUTHOR]

An eleven-year-old Galgo Espagnol was diagnosed with metastasized anal sac adenocarcinoma. The patient was enrolled into a clinical trial and underwent three “whole-body thermal therapy” (WBTT) sessions combined with four hypofractionated radiotherapy sessions during a ten-weeks’ time period. The medical device and corresponding treatment protocol were designed by ElmediX (ElmediX NV, Belgium). Air was injected at high speed in a treatment chamber and automatically regulated to reach and maintain a body temperature of 41.5°C for eight hours. Thermometry was ensured by temperature sensors placed in and on the patient. During four radiotherapy sessions, an external beam delivered hypofractionated doses of 6Gy on both the primary tumor and the metastatic lymph nodes. Clinical monitoring and assessment of quality of life confirmed that the WBTT sessions were well tolerated. Although burn wounds at pressure points occurred, prolonged severe adverse effects were not observed. Furthermore, the disease progression was deemed slower than the expected progression based on the literature. [ABSTRACT FROM AUTHOR]

Background: In particular older people are at risk of mortality due to corona virus disease 2019 (COVID-19). Advance care planning is essential to assist patient autonomy and prevent non-beneficial medical interventions. Aim: To describe early (taken within 72 h after hospital admission) resuscitation orders in oldest-old hospitalized with COVID-19. Setting/participants: A cohort of patients aged 80 years and older admitted to the acute hospital in March and April 2020 with COVID-19 were retrospectively recruited from 10 acute hospitals in Belgium. Recruitment was done through a network of geriatricians. Results: Overall, 766 octogenarians were admitted of whom 49 were excluded because no therapeutic relationship with the geriatrician and six because of incomplete case report form. Early decisions not to consider intensive care admission were taken in 474/711 (66.7%) patients. This subgroup was characterized by significantly higher age, higher number of comorbidities and higher frailty level. There was a significant association between the degree of the treatment limitation and the degree of premorbid frailty (p < 0.001). Overall in-hospital mortality was 41.6% in patients with an early decision not to consider intensive care admission (67.1% in persons who developed respiratory failure vs 16.7% in patients without respiratory failure (p < 0.001)). Of 104 patients without early decision not to consider intensive care admission but who developed respiratory failure, 59 were eventually not transferred to intensive care unit with in-hospital mortality of 25.4%; 45 were transferred to the intensive care unit with mortality of 64.4%. Conclusions: Geriatricians applied all levels of treatment in oldest-old hospitalized with COVID-19. Early decisions not to consider intensive care admission were taken in two thirds of the cohort of whom more than 50% survived to hospital discharge by means of conservative treatment. [ABSTRACT FROM AUTHOR]

Summary: Multiple factors increase the risk of an imminent fracture, including a recent fracture, older age, osteoporosis, comorbidities, and the fracture site. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate treatment. Introduction: The risk of a recurrent fragility fracture is maximal during the first 2 years following an incident fracture. In this prospective cohort study, we looked at the incidence of recurrent fractures within 2 years after a first incident fracture and we assessed independent clinical risk factors (CRFs) increasing this imminent fracture risk. Methods: A total of 3560 postmenopausal women recruited from 2007 to 2013 were surveyed yearly for the occurrence of fragility fractures. We identified patients who sustained a fracture during the first 2 years following a first incident fragility fracture. We quantified the risk of a new fracture and assessed independent CRFs, associated with an imminent fracture at various sites. Results: A recent fracture was a significant CRF for an imminent fracture (OR (95% CI): 3.7 (2.4–5.7) [p < 0.0001]). The incidence of an imminent fracture was higher in subjects above 80 years (p < 0.001). Other CRFs highly predictive in a multivariate analysis were osteoporosis diagnosis (p < 0.01), a central fracture as the index fracture (p < 0.01), and the presence of comorbidities (p < 0.05), with likelihood ratios of 1.9, 1.9, and 2.2, respectively. An imminent fracture was better predicted by a central fracture (p < 0.01) than by a major osteoporotic fracture. The hazard ratio was the highest for a central fracture. Conclusion: In patients with a recent fracture, older age, osteoporosis, comorbidities, and fracture site were associated with an imminent fracture risk. These findings could be a first step in the development of a model to predict an imminent fracture and select patients most at need of immediate and most appropriate treatment. [ABSTRACT FROM AUTHOR]

Background: With the improvement of life expectancy, the world faces increasing demands for care of older persons. In this manuscript, we define the characteristics of primary informal caregivers (PIC) of patients aged 75 years and older admitted to geriatric day hospitals (GDH) in Belgium. A PIC is defined as the person who most often provides care and assistance to persons who need to be cared for. We describe PIC socio-demographic characteristics, satisfaction, burden and wishes about caring; the type of assistance provided and received, their self-rated health, socio-demographic and medical characteristics of proxies, in particular the presence of behavioural disorders.Methods: We conducted a cross-sectional study in 25 GDH.Participants: Four hundred seventy-five PIC of patients ≥75 years and their proxies. PIC completed a questionnaire at the GDH assessing burden by Zarit Burden Index-12 (ZBI-12), self-rated health, social restriction due to caregiving and financial participation. We compared the characteristics of PIC with high and low burden, and the characteristics of spouses and adult children PIC. We also analyzed factors associated with a high burden in a multivariable logistic regression model.Results: PIC were mainly women (72%), adult children (53.8%) and spouses (30.6%). The mean age was 64 ± 14 years for PIC and 84 ± 5 years for care recipients. PIC helped for most of Activities in Daily Living (ADL) and Instrumental ADL (iADL). The median ZBI-12 score was 10 [IQR 5-18]. In multivariable regression analysis, a high burden was positively associated in the total group with living with the relative (p = 0.045), the difficulty to take leisure time or vacation (p <  0.001), behavioral and mood disorders (p <  0.001;p = 0.005), and was negatively associated with bathing the relative (p = 0.017) and a better subjective health status estimation (p <  0.001).Conclusion: Primary informal caregivers, who were predominantly women, were involved in care for ADL and iADL. A high burden was associated with living with the relative, the difficulty to take leisure time or vacation and the relative's behavioral and mood disorders. Bathing the relative and a subjective health status estimated as good as or better than people the same age, were protective factors against a high burden. [ABSTRACT FROM AUTHOR]

Background The extent to which patients are involved in their care can be influenced by hospital policies and interventions. Nevertheless, the implementation of patient participation and involvement (PPI) at the organisational (meso) level has rarely been assessed systematically. The aim of this study was to assess the occurrence of PPI practises in hospitals in Belgium, France, Germany and Luxembourg and to analyze if, and to what extent, the hospital vision and the presence of a patient committee influence the implementation of PPI practises. Methods A cross-sectional study was carried out using an online questionnaire in hospitals in the border regions of the four countries. The data were analyzed for differences between regions and the maturity of PPI development. Results Full responses were obtained from 64 hospitals. A wide range of practices were observed, the degree of maturity was mixed. A majority of hospitals promoted patient partnership in the hospital's philosophy of care statement. However, the implementation of specific interventions for PPI was not found uniformly and differences could be observed between the countries. Conclusions Hospitals in the region seem to be motivated to include patients more fully, however, implementation of PPI interventions seems incomplete and only partially integrated into the general functioning of the hospitals. The implementation of the concept seems to be more mature in the francophone part of the region perhaps due, in part, to a more favourable political context. [ABSTRACT FROM AUTHOR]

Mesothelioma is a rare cancer caused by exposure to asbestos. Belgium has a known long history of asbestos production, resulting in one of the highest mesothelioma mortality rates worldwide. While the production of asbestos has stopped completely, the long latency period of mesothelioma, which can fluctuate between 20 and 40 years after exposure, causes incidences still to be frequent. Mesothelioma's long incubation time affects our assessment of its geographical distribution as well. Since patients' residential locations are likely to change a number of times throughout their lives, the location where the patients develop the disease is often far from the location where they were exposed to asbestos. Using the residential history of patients, we propose the use of a convolution multiple membership model (MMM), which includes both a spatial conditional autoregressive and an unstructured random effect. Pancreatic cancer patients are used as a control population, reflecting the population at risk for mesothelioma. Results show the impact of the residential mobility on the geographical risk estimation, as well as the importance of acknowledging the latency period of a disease. A simulation study was conducted to investigate the properties of the convolution MMM. The robustness of the results for the convolution MMM is assessed via a sensitivity analysis. [ABSTRACT FROM AUTHOR]

Recently, studies have burgeoned on the link between populism and demands for democratic reforms. In particular, scholars have been debating the link between populist citizens or voters and support for referendums. In this article, we examine voters of populist parties (Vlaams Belang (VB) and Parti du Travail de Belgique- Partij van de Arbeid (PTB-PVDA)) in Belgium in 2019 and we look at their attitudes towards various types of democratic reforms. We find that voters of populist parties differ from the non-populist electorate in their support for different kinds of reforms of representative democracy. Voters of VB and PTB-PVDA have in common stronger demands for limiting politicians' prerogatives, for introducing binding referendums and for participatory budgeting. While Vlaams Belang voters are not significantly different from the non-populist electorate on advisory referendums, citizens' forums or technocratic reform, PVDA-PTB voters seem more enthusiastic. [ABSTRACT FROM AUTHOR]

Summary: Asparaginase (ASNase) is an important anti‐leukaemic drug in the treatment of childhood acute lymphoblastic leukaemia (ALL) and non‐Hodgkin lymphoma (NHL). A substantial proportion of patients develop hypersensitivity reactions with anti‐ASNase neutralising antibodies, resulting in allergic reactions or silent inactivation (SI), and characterised by inactivation and rapid clearance of ASNase. We report results of a prospective, real‐time therapeutic drug monitoring of pegylated Escherichia coli (PEG‐)ASNase and Erwinia ASNase in children treated for ALL and NHL in Belgium. Erwinia ASNase was given as second‐line after hypersensitivity to PEG‐ASNase. In total, 286 children were enrolled in the PEG‐ASNase cohort. Allergy was seen in 11·2% and SI in 5·2% of patients. Of the 42 patients treated with Erwinia ASNase, 7·1% experienced allergy and 2·4% SI. The median trough PEG‐ASNase activity was high in all patients without hypersensitivity. After Erwinia administration significantly more day 3 samples had activities <100 IU/l (62·5% vs. 10% at day 2 (D2)). The median D2 activity was significantly higher for intramuscular (IM; 347 IU/l) than for intravenous Erwinia administrations (159 IU/l). This prospective, multicentre study shows that monitoring of ASNase activity during treatment of children with ALL and NHL is feasible and informative. Treatment with Erwinia ASNase warrants close monitoring and optimally adherence to a 2‐day interval of IM administrations. [ABSTRACT FROM AUTHOR]

A large sample study (n = 513) was conducted to investigate executive control performance in pupils following an immersion education program. We recruited 10-year-old children (n = 128) and 16-year-old adolescents (n = 127) who were enrolled in English or Dutch immersion education in French-speaking Belgium for at least 4 school years. They were compared to non-immersed children (n = 102) and adolescents (n = 156) on a number of executive control tasks assessing inhibitory control, monitoring, switching and attentional abilities. Several control variables such as receptive vocabulary, nonverbal intelligence, socioeconomic status and other potentially relevant background variables were also considered. Our results show significant gains in foreign-language proficiency for the immersed compared to the non-immersed participants. These gains were however not associated with any measurable benefits on executive control. Our findings make a unique contribution to understanding how language and cognition develop through formal education methods that promote bilingualism. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has compelled public authorities to establish preventive measures involving individual behaviour modification strategies (mask-wearing, social distancing, etc.) with a view to community protection. In this context, documenting people's behaviour changes, the impact of public health measures, and individuals' knowledge, motivations, and beliefs – even their perception of how the crisis is being managed – is essential for understanding the experience of the population and adapting the management approach accordingly. This article presents findings and lessons on how to monitor a population's behaviour during a crisis, obtained by reviewing forty-five surveys conducted in Belgium and France during the first Covid-19 stay-at-home order, from April to May 2020. The central message is to argue that the citizens' role in this type of survey – and in managing the crisis, more generally – should be reconsidered by thinking of them as true health partners and members of a community that could be mobilised to help. [ABSTRACT FROM AUTHOR]

For more than two decades, scholars have been debating the so-called personalization of politics. Some studies confirm such an evolution, while others demonstrate that evidence of personalization is at best mixed, or even absent. This article aims at shedding a new light on this controversy by looking at the evolution of the use of preferential voting in Belgium. Preferential voting has been constantly growing, but since 2007, the trend has been reversed and fewer voters decide to cast a preferential vote. We argue that this decline is not evidence against personalization. Rather, it illustrates the need to distinguish conceptually and empirically between two dimensions of personalization: ‘centralized’ and ‘decentralized’ personalization. The decline in the use of preference votes is not related to a decline in the former (which refers to a handful of political leaders). Instead, it is due to the decline of the latter form of personalization (referring to a large group of individual politicians). Candidates other than party leaders appear to have growing difficulties to attract votes. This negative relationship holds, even when we control for measures of electoral reform and the newness of parties. Our results also show that leadership effects are stronger in new parties. [ABSTRACT FROM AUTHOR]

An improved general understanding of riverbed heterogeneity is of importance for all groundwater modeling studies that include river-aquifer interaction processes. Riverbed hydraulic conductivity ( K ) is one of the main factors controlling river-aquifer exchange fluxes. However, the meter-scale spatial variability of riverbed K has not been adequately mapped as of yet. This study aims to fill this void by combining an extensive field measurement campaign focusing on both horizontal and vertical riverbed K with a detailed geostatistical analysis of the meter-scale spatial variability of riverbed K . In total, 220 slug tests and 45 standpipe tests were performed at two test sites along the Belgian Aa River. Omnidirectional and directional variograms (along and across the river) were calculated. Both horizontal and vertical riverbed K vary over several orders of magnitude and show significant meter-scale spatial variation. Horizontal K shows a bimodal distribution. Elongated zones of high horizontal K along the river course are observed at both sections, indicating a link between riverbed structures, depositional environment and flow regime. Vertical K is lognormally distributed and its spatial variability is mainly governed by the presence and thickness of a low permeable organic layer at the top of the riverbed. The absence of this layer in the center of the river leads to high vertical K and is related to scouring of the riverbed by high discharge events. Variograms of both horizontal and vertical K show a clear directional anisotropy with ranges along the river being twice as large as those across the river. [ABSTRACT FROM AUTHOR]

Objective: Our objectives were to (1) describe the evolution of the underuse of anticoagulants in older people with atrial fibrillation (AF) and a CHADS score ≥ 2 since direct oral anticoagulants (DOACs) were introduced to the market and (2) describe factors associated with this underuse. Methods: We conducted a retrospective cross-sectional study including geriatric patients admitted during the pre-DOAC (2008-2011) and post-DOAC (2013-2015) periods in an academic hospital in Belgium. Five inclusion criteria were met: age ≥ 75 years, diagnosis of AF, indication for anticoagulation (CHADS score ≥ 2), risk of functional decline (Identification of Seniors At Risk [ISAR] score ≥ 2), and comprehensive geriatric assessment. The use of anticoagulants and antiplatelets at home before admission was recorded. Risks of stroke and bleeding were calculated using CHADS and HEMORRHAGES scores, respectively. Three different logistic regression models were performed to describe the evolution of and factors associated with the underuse of anticoagulants after DOAC marketing. Results: Anticoagulant underuse, present in 209 of 614 (34%) geriatric patients with AF, was lower in patients with a history of stroke (28.5%) or congestive heart failure (26.9%) but higher in those receiving antiplatelets (56.2%) and in older individuals. Anticoagulant underuse decreased significantly from the pre-DOAC (37.3%) to the post-DOAC (29.7%) era, as shown by two analyses using propensity scores. Conclusion: In older patients with AF, anticoagulant underuse was mainly associated with antiplatelet use. Anticoagulant underuse and antiplatelet use have both decreased since DOAC marketing. Underuse of anticoagulants was still a concern for three in ten geriatric patients with AF at high risk of stroke (CHADS score ≥ 2). [ABSTRACT FROM AUTHOR]