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This contribution offers a reflection on the theme of religious educational leadership (REL) at a time when the coronavirus (COVID-19) pandemic is gripping society. The main question that guides the contribution is: How does one practice REL in theological education during COVID-19 and its accompanying measures? In answering this question, the author reflects on his own experiences as a rector on a theological faculty in Belgium and brings these experiences into conversation with the literature on the role of normativity in religious education (RE). This contribution presents a number of normative positions and discourses in leadership at the time of COVID-19 and invites the reader to reflect on the issue of normativity in their own practices of bridge-building leadership.

As decolonization?of the curriculum in higher education (HE) gains traction, academics?may question?their positionality and role as actors in the field. The concept of decolonization is contentious, but primarily focuses on uncentering the?Western?filter through which the world is viewed both socially and academically. Just as Gavin Sanderson has argued, that internationalization of HE requires the internationalization of the academic self, so we discuss how decolonizing the internationalized HE curriculum must begin with the decolonization of the individual. The strategic directions of our three European institutions reflect the tensions reported in international literature between HE as an income generator, and as a public good. In the autoethnographic project underpinning this article, we employed the unconventional Collaborative Analytics methodology and its iterations of "share data, share results, share decisions" to explore institutional strategy as experienced by academics. Our novel approach may help others reflect on decolonizing as a process of 'forever becoming'.

Most studies on branding in higher education focus on external branding or image-building towards external stakeholders such as students. Internal branding is an underexplored topic, even though it should be considered as important as external branding. Internal branding is about achieving the necessary internal support for the external brand. Drawing on the theoretical concept of discursive legitimation, we explore the strategies that contribute to an internally supported new brand with student diversity as brand value. We conducted a case study of a Flemish university college that has (largely) succeeded in achieving internal support for its new external brand of student diversity. Analyzing the case from the perspective of Critical Discourse Analysis, we specifically zoomed in on the dialectical tensions underlying the discursive legitimation of this new brand. We identified three specific tensions, which illustrate the inherent complexity of the internal branding process: authorization as (dis)empowerment, normalization as (dis)empowerment and moralization as (dis)empowerment.

Introduction: Older adults face a higher risk of vancomycin-related toxicity given their (patho)-physiological changes, making early management of supratherapeutic exposure crucial. Yet, data on vancomycin exposure in older adults is scarce. This study aims to compare vancomycin concentrations between older and younger patients, emphasizing supratherapeutic concentrations and the effect of patient characteristics. Methods: This observational retrospective study was conducted in the University Hospital of Leuven (EC Research S65213). We analyzed early (first) vancomycin concentrations between older (≥ 75 years) and younger patients. Multivariable analyses were conducted to evaluate the association between baseline patient characteristics with supratherapeutic exposure (logistic regression), and dose-normalized concentrations (linear regression). Results: We included 449 patients aged ≥ 75 years (median 80) and 1609 aged < 75 years (median 61). In univariable analysis, the first-measured vancomycin concentrations were significantly higher in older adults (p < 0.001), who more frequently reached supratherapeutic concentrations (30.7% versus 21%; p < 0.001). In multivariable analysis, factors associated with supratherapeutic concentrations were decreased the estimated glomerular filtration rate calculated by using the Chronic Kidney Disease Epidemiology Collaboration equation (eGFRCKD-EPI) [odds ratio (OR) of 0.98, confidence interval (CI) 0.97–0.98]. Supratherapeutic concentrations had inverse association with giving lower loading dose (OR of 0.59, CI 0.39–0.90), and lower maintenance dose (OR of 0.45, CI 0.26–0.77). Factors that predicted increased dose-normalized concentrations included decreased eGFRCKD-EPI (coefficient of −0.05, CI −0.06 to −0.04), lower body weight (coefficient of −0.04, CI −0.05 to −0.03), increased blood urea nitrogen (coefficient of 0.02, CI 0.01–0.03), and delayed time to therapeutic drug monitoring (TDM) sampling (coefficient of 0.08, CI 0.06–0.09). Conclusions: The absence of age as a significant factor in the multivariable analysis suggests that eGFRCKD-EPI mediated the relationship between age and vancomycin exposure. Older adults may benefit more from vancomycin TDM. [ABSTRACT FROM AUTHOR]

Background: Polypharmacy is a growing concern, impacting patient safety and healthcare costs. Monitoring its prevalence and temporal trends is essential for effective healthcare management. Aim: This study aimed to determine prevalence and trends of polypharmacy and excessive polypharmacy in Belgium. Method: Utilizing a federal claims database, medication data were analyzed from 2012 to 2021. Polypharmacy (≥ 5 medications) and excessive polypharmacy (≥ 10 medications) were evaluated, with prevalence calculated per 1000 inhabitants, and reported per year, age group and region. Linear regression estimated the impact of age and year on polypharmacy prevalence. Results: In 2021, polypharmacy and excessive polypharmacy were reported in 135/1000 and 31/1000 Belgians respectively. Prevalence of both increased steadily from 2012 to 2021, with excessive polypharmacy rising more prominently. Among adults aged ≥ 65 years, prevalence rates were higher, with polypharmacy at 434/1000 and excessive polypharmacy at 106/1000. Regional variations were observed, with prevalence highest in the Walloons region. Patient age and year (2012–2021) were associated with both polypharmacy and excessive polypharmacy (p < 0.001). Conclusion: We observed increases in polypharmacy and excessive polypharmacy over a decade in Belgium, particularly among older adults. Efforts to monitor, manage, and optimize medication use are imperative to ensure safe and effective healthcare delivery. [ABSTRACT FROM AUTHOR]

This study investigated the decision-making process of three instructional groups (i.e., teacher-centered, student-centered with tactical questioning and student-centered without tactical questioning) in practical courses in volleyball among university students. All students (N = 122) performed a Tactical Awareness task on the correctness of the decision-making process at three testing phases (i.e., pretest, posttest and retention test). The results revealed that the tactical awareness of all students ameliorated after five lessons (posttest) and this effect persisted over time after six weeks (retention test). However, the tactical knowledge of the student-centered instructional group with tactical questioning improved significantly more than the two other instructional groups. These findings highlight the importance of a student-centered approach with an active involvement of students in evaluative skills to enhance the tactical decision-making process. (Contains 1 table and 3 figures.)

Within this article we will introduce some metaphors as they were developed and used by mothers and fathers we worked with: the traveller, the warrior, the builder of bridges, the discoverer, the trainer/teacher, the in-between-er, the manager...We will position these metaphors as tools parents are using in their confrontation with normalising discourses of disability and education. In this sense mothers and fathers of disabled children can be seen as "parents on the margins" from whom we can learn a lot about parenting in general. In that sense the metaphors we will present can be situated as a meta level parents present in their continuing process of reflection on their living together with their children with disabilities. (Contains 1 note.)

A present-day engineer has a large scientific knowledge; he is a team-player, eloquent communicator and life-long learner. At the Katholieke Universiteit Leuven, the course "Problem Solving and Engineering Design" introduces engineering students from the first semester onwards into real engineering practice and teamwork. Working in small groups, the students integrate basic principles of all regular scientific courses to solve real-life engineering problems. This makes the coursework more interesting and helps the students to master the abstract theories presented in lectures. Through the increasing complexity of the assignments, the students are gradually confronted with technical and social competencies such as a systematic approach to problem solving and engineering design, teamwork, project management and communication skills. "Problem Solving and Engineering Design" has been implemented in the bachelor of engineering since September 2003. The current paper describes the course objectives, the way the course is implemented to support project-based learning and the feedback obtained from the didactic team and the students. (Contains 2 tables and 9 figures.)

The SALOMON project automatically summarizes Belgian criminal cases to improve access to existing and future court decisions. This article gives background information about the texts of the cases and describes the output, design models, and architecture of the SALOMON system. Evaluation of 700 criminal cases demonstrates that the algorithms have an application potential for automatic indexing, abstracting, and text linking. (Author/AEF)

Background: Allergic rhinitis includes a certain degree of autonomic imbalance. However, no information is available on how daily changes in allergy burden affect autonomic imbalance. We aimed to estimate associations between daily allergy burden (allergy symptoms and mood) and daily heart rate characteristics (resting heart rate and sample entropy, both biomarkers of autonomic balance) of adults with allergic rhinitis, based on real‐world measurements with a wearable telemonitoring system. Methods: Adults with a tree pollen allergy used a smartphone application to self‐report daily allergy symptoms (score 0–44) and mood (score 0–4), and a Mio Alpha 2 wristwatch to collect heart rate characteristics during two pollen seasons of hazel, alder and birch in Belgium. Associations between daily allergy burden and heart rate characteristics were estimated using linear mixed effects distributed lag models with a random intercept for individuals and adjusted for potential confounders. Results: Analyses included 2497 participant‐days of 72 participants. A one‐point increase in allergy symptom score was associated with an increase in next‐day resting heart rate of 0.08 (95% CI: 0.02–0.15) beats per minute. A one‐point increase in mood score was associated with an increase in same‐day sample entropy of 0.80 (95% CI: 0.34–1.26) × 10−2. No associations were found between allergy symptoms and heart rate sample entropy, nor between mood and resting heart rate. Conclusion: Daily repeated measurements with a wearable telemonitoring system revealed that the daily allergy burden of adults with allergic rhinitis has systemic effects beyond merely the respiratory system. [ABSTRACT FROM AUTHOR]

Purpose: Traumatic brain injury (TBI) rates in the elderly population are rapidly increasing worldwide. However, there are no clinical guidelines for the treatment of elderly TBI to date. This study aims at describing injury patterns and severity, clinical management, and outcomes in elderly TBI patients, which may contribute to specific prognostic tools and clinical guidelines in the future. Methods: Clinical records of 2999 TBI patients ≥ 65 years old admitted in the University Hospital Leuven (Belgium) between 1999 and 2019 were manually screened and 1480 cases could be included. Records were scrutinized for relevant clinical data. Results: The median age in the cohort was 78.0 years (IQR = 12). Falls represented the main accident mechanism (79.7%). The median Glasgow Coma Score on admission was 15 (range 3–15). Subdural hematomas were the most common lesion (28.4%). 90.1% of all patients were hospitalized and 27.0% were admitted to intensive care. 16.4% underwent a neurosurgical intervention. 11.0% of all patients died within 30 days post-TBI. Among the 521 patients with mild TBI, 28.6% were admitted to ICU and 13.1% had a neurosurgical intervention and 30-day mortality was 6.9%. Conclusion: Over the 20-year study period, an increase of age and comorbidities and a reduction in neurosurgical interventions and ICU admissions were observed, along with a trend to less severe injuries but a higher proportion of treatment withdrawals, while at the same time mortality rates decreased. TBI is a life-changing event, leading to severe consequences in the elderly population, especially at higher ages. Even mild TBI is associated with substantial rates of hospitalization, surgery, and mortality in elderly. The characteristics of the elderly population with TBI are subject to changes over time. [ABSTRACT FROM AUTHOR]

Sustainable flood risk management encompasses the implementation of nature-based solutions to mitigate flood risk. These measures include the establishment of land use types with a high (e.g., forest patches) or low (e.g., sealed surfaces) water retention and infiltration capacity at strategic locations in the catchment. This paper presents an approach for assessing the relative impact of such land use changes on economic flood damages and associated risk. This spatially explicit approach integrates a reference situation, a flood damage model, and a rainfall-runoff model considering runoff re-infiltration and propagation to determine relative flood risk mitigation or increment related to the implementation of land use change scenarios. The applicability of the framework is illustrated for a 4800 ha undulating catchment in the region of Flanders, Belgium, by assessing the afforestation of 187.5 ha (3.9 %), located mainly in the valleys, and sealing of 187.5 ha, situated mainly at higher elevations. These scenarios result in a risk reduction of 57 % (EUR 100 000) for the afforestation scenario and a risk increment of <1 % (EUR ∼ 500) for the sealing scenario. [ABSTRACT FROM AUTHOR]

Background older people with cancer are at risk of complex and fluctuating health problems, but little is known about the extent to which their well-being changes in the last years of life. Objective to examine changes in physical, psychological and social well-being in the last 5 years of life of older people with cancer. Design prospective cohort study. Setting Belgium, the Netherlands. Participants people with a new primary diagnosis of breast, prostate, lung or gastrointestinal cancer, aged ≥70 years, life expectancy >6 months, were recruited from nine hospitals. We analysed data of deceased patients. Methods data were collected from participants around diagnosis, and after 6 months, 1, 3 and 5 years through structured questionnaires administered through interviews or as self-report. Outcomes were physical, emotional, social, role functioning (EORTC QLQ-C30), depressive symptoms (GDS-15), emotional and social loneliness (Loneliness Scale). We conducted linear mixed model analyses. Results analysing 225 assessments from 107 deceased participants (assessments took place between 1,813 and 5 days before death), mean age at baseline 77 years (standard deviation: 5.2), we found statistically significant deterioration in physical functioning (b  = 0,016 [95%confidence interval 0.009–0.023]), depressive symptoms (b  = −0,001 [−0.002 to 0.000]) and role functioning (b  = 0.014 [0.004–0.024]). Changes over time in emotional and social functioning and in social and emotional loneliness were smaller and statistically non-significant. Conclusions care towards the end of life for older people with cancer needs to put their social and psychological well-being at the centre, alongside physical needs. Future research should focus on understanding inter-individual variation in trajectories. [ABSTRACT FROM AUTHOR]

Sustainable flood risk management encompasses the implementation of nature-based solutions to mitigate flood risk. These measures include the establishment of land use types with a high (e.g. forest patches) or low (e.g. sealed surfaces) water retention and infiltration capacity at strategic locations in the catchment. This paper presents an approach for assessing the relative impact of such land use changes on economic flood damages and associated risk. This spatially explicit approach integrates a reference situation, a flood damage model and a rainfall-runoff model, considering runoff re-infiltration and propagation, to determine relative flood risk mitigation or increment related to the implementation of land use change scenarios. The applicability of the framework is illustrated for a 4800 ha undulating catchment in the region of Flanders, Belgium by assessing afforestation of 187.5 ha (3.9 %), located mainly in the valleys, and sealing of 187.5 ha, situated mainly at higher elevations. These scenarios result in a risk reduction of 57 % (100 856 €) for the afforestation scenario and a risk increment of < 1 % (535 €) for the sealing scenario. [ABSTRACT FROM AUTHOR]

Soil sealing increases surface runoff in a watershed and decreases infiltration into the soil. Consequently, urbanization poses a significant challenge for watershed management to mitigate faster runoff accumulation downstream and associated floods. Hydrological models are often employed to assess the impact of land-use dynamics on flood events. Alternatively, data-driven approaches combining time series of land use geodatasets and georeferenced flooded zones also allow to assess the relationship between soil sealing and flood severity. This study presents such data-driven analysis using a spatially explicit archive of flooded areas dating back to 1988 in the Flanders region of Belgium, which is characterized by urban sprawl. This archived data, along with time series of rainfall and land use, were analyzed for three middle-sized river subbasins using two machine learning methods: boosted regression trees and support vector regression. The machine learning methods were found suitable for this type of analysis, since their flexibility allows for spatially explicit models with larger sample sizes. However, the relationship between soil sealing and flood volume and extent could not be conclusively confirmed by our models. This may be due to data limitations, such as the limited number of recorded historical floods, inaccuracies in recorded historical flood polygons and inconsistencies in the land use classifications. It is therefore stressed that continued consistent monitoring of floods and land use changes is required. [ABSTRACT FROM AUTHOR]

Storage of soil organic carbon (SOC) is an essential function of ecosystems underpinning the delivery of multiple services to society. Regional SOC stock estimates often rely on data collected during land‐use‐specific inventory schemes with varying sampling depth and density. Using such data requires techniques that can deal with the associated heterogeneity. As the resulting SOC assessments are not calibrated for the local scale, they could suffer from oversimplification of landscape processes and heterogeneity. This might especially be the case for sandy regions where typical historical land use practices and soil development processes determine SOC storage. The aims of this study were (a) to combine four land‐use‐specific SOC stock assessments to estimate the total stock in Flanders, Belgium, and (b) to evaluate the applicability of this regional‐scale estimate at the local scale. We estimated the SOC stock in the upper 100 cm of the unsealed area in Flanders (887,745 ha) to be 111.67 Mt OC, or 12.6 ± 5.65 kg OC m−2 on average. In general, soils under (semi‐) natural land‐use types, for example forests, store on average more organic carbon than under agriculture. However, overall agricultural soils store the largest amounts of SOC due to their vast spatial extent. Zooming in on a sandy location study (13.55 km2) revealed the poor performance of the regional estimates, especially where Histosols occurred. Our findings show that a greater spatial sampling density is required when SOC stock estimates are needed to inform carbon‐aware land management rather than to provide for regional reporting. [ABSTRACT FROM AUTHOR]

Background Clinical pharmacist interventions have been shown to improve drug use in older adults. Study findings are seldom externally validated however. Objective First, to validate a minimized iteration of a previously tested intervention of clinical pharmacists in a non-academic setting with limited staffing resources. Second, to compare the potentially inappropriate medication (PIM) reduction to two previous controlled interventional studies. Methods A controlled study was performed at geriatric wards. The control group received usual care. The intervention group was exposed to a clinical pharmacist led medication review, based on the use of the RASP list, (the Rationalization of Home Medication by an Adjusted STOPP list in Older Patients). Drug use on admission and at discharge were evaluated, including the number of RASP-identified potentially inappropriate medications (PIMs). The PIM reduction was compared to two previous controlled study findings using a linear mixed model. Results Drug use declined during hospital stay, without differences between control (n = 29) and intervention group (n = 32). Antidepressants and hypnotic drugs were discontinued more frequently in IG patients. More PIMs were reduced in the intervention patients (control vs. intervention: 1.0 vs. 3.0, p < 0.001). Across three controlled studies, a robust reduction of 1.56 PIMs (95% confidence interval 1.10-2.02, p < 0.001) was observed in favor of the CP interventions. Conclusion The minimal CP intervention resulted in fewer RASP PIMs. No net reduction of drug use was observed, yet fewer antidepressants and hypnotic drugs were used. The RASP PIM reduction was comparable to previous investigations. [ABSTRACT FROM AUTHOR]

Purpose: Psychological frailty adds most to overall feelings of frailty, but is often neglected, although meaning in life is important for psychological well-being. The purpose of this paper is to explore the sources of meaning in life within psychologically frail older people. Design/methodology/approach: Data (n= 16,872) generated from the Belgian Ageing Studies were collected, using the Comprehensive Frailty Assessment Instrument and the Sources of Meaning Profile (SOMP-R) instrument. Psychometric properties of the SOMP-R were explored using factor and reliability analysis and one-way-ANOVA analysis were used to asses mean differences. Findings: Financial security, meeting basic needs and personal relations play an important role as sources of meaning in life. Moreover, the SOMP-R showed excellent psychometric properties. Research limitations/implications: Due to the cross-sectional design of this study, evolution in time and causal links could not be assessed. Practical implications: The findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed. The results show that, meaning in life as such plays an important role for psychologically frail older people. As a consequence, this offers insights to support these older people. Caregivers and policymakers might therefore take these results into account. Guarantee and/or follow up a frail individual's financial security, assessing and enabling one's personal relationships and meeting their basic needs are very important when taking care of psychologically frail older individuals. Social implications: Besides the practical implications, the social inclusion of psychologically frail older people seems to be relevant. Originality/value: To the best of the authors' knowledge, the association between meaning in life and psychological frailty in later life is not yet investigated. Further the findings of this study emphasize that sources of meaning in life are relevant and can be assessed using the SOMP-R upon which individually tailored care plans can be developed. [ABSTRACT FROM AUTHOR]

Background: The knowledge of circulating HCV genotypes and subtypes in a country is crucial to guide antiviral therapy and to understand local epidemiology. Studies investigating circulating HCV genotypes and their trends have been conducted in Belgium. However they are outdated, lack nationwide representativeness or were not conducted in the general population. Methods: In order to determine the distribution of different circulating HCV genotypes in Belgium, we conducted a multicentre study with all the 19 Belgian laboratories performing reimbursed HCV genotyping assays. Available genotype and subtype data were collected for the period from 2008 till 2015. Furthermore, a limited number of other variables were collected: some demographic characteristics from the patients and the laboratory technique used for the determination of the HCV genotype. Results: For the study period, 11,033 unique records collected by the participating laboratories were used for further investigation. HCV genotype 1 was the most prevalent (53.6%) genotype in Belgium, with G1a and G1b representing 19.7% and 31.6%, respectively. Genotype 3 was the next most prevalent (22.0%). Further, genotype 4, 2, and 5 were responsible for respectively 16.1%, 6.2%, and 1.9% of HCV infections. Genotype 6 and 7 comprise the remaining <1%. Throughout the years, a stable distribution was observed for most genotypes. Only for genotype 5, a decrease as a function of the year of analysis was observed, with respectively 3.6% for 2008, 2.3% for 2009 and 1.6% for the remaining years. The overall M:F ratio was 1.59 and was mainly driven by the high M:F ratio of 3.03 for patients infected with genotype 3. Patients infected with genotype 3 are also younger (mean age 41.7 years) than patients infected with other genotypes (mean age above 50 years for all genotypes). The patients for whom a genotyping assay was performed in 2008 were younger than those from 2015. Geographical distribution demonstrates that an important number of genotyped HCV patients live outside the Belgian metropolitan cities. Conclusion: This national monitoring study allowed a clear and objective view of the circulating HCV genotypes in Belgium and will help health authorities in the establishment of cost effectiveness determinations before implementation of new treatment strategies. This baseline characterization of the circulating genotypes is indispensable for a continuous surveillance, especially for the investigation of the possible impact of migration from endemic regions and prior to the increasing use of highly potent direct-acting antiviral (DAA) agents. [ABSTRACT FROM AUTHOR]

Background: Magnetic resonance imaging (MRI) acquisition/processing techniques assess brain volumes to explore neurodegeneration in Alzheimer's disease (AD).Objective: We examined the clinical utility of MSmetrix and investigated if automated MRI volumes could discriminate between groups covering the AD continuum and could be used as a predictor for clinical progression.Methods: The Belgian Dementia Council initiated a retrospective, multi-center study and analyzed whole brain (WB), grey matter (GM), white matter (WM), cerebrospinal fluid (CSF), cortical GM (CGM) volumes, and WM hyperintensities (WMH) using MSmetrix in the AD continuum. Baseline (n = 887) and follow-up (FU, n = 95) T1-weighted brain MRIs and time-linked neuropsychological data were available.Results: The cohort consisted of cognitively healthy controls (HC, n = 93), subjective cognitive decline (n = 102), mild cognitive impairment (MCI, n = 379), and AD dementia (n = 313). Baseline WB and GM volumes could accurately discriminate between clinical diagnostic groups and were significantly decreased with increasing cognitive impairment. MCI patients had a significantly larger change in WB, GM, and CGM volumes based on two MRIs (n = 95) compared to HC (FU>24months, p = 0.020). Linear regression models showed that baseline atrophy of WB, GM, CGM, and increased CSF volumes predicted cognitive impairment.Conclusion: WB and GM volumes extracted by MSmetrix could be used to define the clinical spectrum of AD accurately and along with CGM, they are able to predict cognitive impairment based on (decline in) MMSE scores. Therefore, MSmetrix can support clinicians in their diagnostic decisions, is able to detect clinical disease progression, and is of help to stratify populations for clinical trials. [ABSTRACT FROM AUTHOR]

Purpose: Immediate treatment of depression and anxiety may not always be necessary in resilient patients. This study aimed to determine remission rates of subthreshold depression and anxiety, incidence rates of major depressive and anxiety disorders, and predictors of these remission and incidence rates in visually impaired older adults after a three-month 'watchful waiting' period.Methods: A pretest-posttest study in 265 visually impaired older adults (mean age 74 years), from outpatient low-vision rehabilitation services, with subthreshold depression and/or anxiety was performed as part of a randomised controlled trial on the cost-effectiveness of a stepped-care intervention. An ordinal logistic regression analysis was conducted. Main outcome measures were: (1) subthreshold depression and anxiety measured with the Centre for Epidemiologic Studies Depression Scale (CES-D) and the anxiety subscale of the Hospital Anxiety and Depression Scale (HADS-A), and (2) depressive and anxiety disorders measured with the Mini International Neuropsychiatric Interview.Results: After a three-month watchful waiting period, depression and anxiety decreased significantly by 3.8 (CES-D) and 1.4 points (HADS-A) (p < 0.001). Of all participants, 34 % recovered from subthreshold depression and/or anxiety and 18 % developed a depressive and/or anxiety disorder. Female gender [odds ratio (OR) 0.49, 95 % confidence interval (CI) 0.28-0.86], more problems with adjustment to vision loss at baseline (OR 1.02, 95 % CI 1.00-1.03), more symptoms of depression and anxiety at baseline (OR 1.06, 95 % CI 1.02-1.10), and a history of major depressive, dysthymic, and/or panic disorder (OR 2.28, 95 % CI 1.28-4.07) were associated with lower odds of remitting from subthreshold depression and/or anxiety and higher odds of developing a disorder after watchful waiting.Conclusions: Watchful waiting can be an appropriate step in managing depression and anxiety in visually impaired older adults. However, female gender, problems with adjustment to vision loss, higher depression and anxiety symptoms, and a history of a depressive or anxiety disorder confer a disadvantage. Screening tools may be used to identify patients with these characteristics, who may benefit more from higher intensity treatment or a shorter period of watchful waiting. [ABSTRACT FROM AUTHOR]

Background: Due to their lack of repair capacity mitochondria are critical targets for environmental toxicants. We studied genes and pathways reflecting mitochondrial responses to short- and medium-term PM10 exposure.Methods: Whole genome gene expression was measured in peripheral blood of 98 adults (49% women). We performed linear regression analyses stratified by sex and adjusted for individual and temporal characteristics to investigate alterations in gene expression induced by short-term (week before blood sampling) and medium-term (month before blood sampling) PM10 exposure. Overrepresentation analyses (ConsensusPathDB) were performed to identify enriched mitochondrial associated pathways and gene ontology sets. Thirteen Human MitoCarta genes were measured by means of quantitative real-time polymerase chain reaction (qPCR) along with mitochondrial DNA (mtDNA) content in an independent validation cohort (n = 169, 55.6% women).Results: Overrepresentation analyses revealed significant pathways (p-value <0.05) related to mitochondrial genome maintenance and apoptosis for short-term exposure and to the electron transport chain (ETC) for medium-term exposure in women. For men, medium-term PM10 exposure was associated with the Tri Carbonic Acid cycle. In an independent study population, we validated several ETC genes, including UQCRH and COX7C (q-value <0.05), and some genes crucial for the maintenance of the mitochondrial genome, including LONP1 (q-value: 0.07) and POLG (q-value: 0.04) in women.Conclusions: In this exploratory study, we identified mitochondrial genes and pathways associated with particulate air pollution indicating upregulation of energy producing pathways as a potential mechanism to compensate for PM-induced mitochondrial damage. [ABSTRACT FROM AUTHOR]

Congenital toxoplasmosis (CT) and cytomegalovirus infection (cCMV) may cause significant morbidity and even fetal or neonatal mortality. We aimed to quantify the disease burden of CT and cCMV in Belgium in terms of disability-adjusted life years (DALYs) and identify data gaps. The public health impact of CT and cCMV in Belgium in 2013 was 188 (95% uncertainty interval [UI], 43-419) and 1976 (95% UI, 757-4067) DALYs, respectively. The major data gaps identified were representative Belgian studies; information on important sequelae, intrauterine mortality, and termination of pregnancy; and late onset sequelae. A scenario analysis showed important increases in years of life lost when the burden due to fetal losses was included and decreases in DALYs when comprehensive CT prevention measures were conducted. Addressing the key data gaps identified may allow generation of the data needed to break the vicious circle of underrecognition. [ABSTRACT FROM AUTHOR]

Background: Air pollution exposure during pregnancy has been associated with adverse birth outcomes and health problems later in life. We investigated sex-specific transcriptomic responses to gestational long- and short-term exposure to particulate matter with a diameter < 2.5 μm (PM2.5) in order to elucidate potential underlying mechanisms of action.Methods: Whole genome gene expression was investigated in cord blood of 142 mother-newborn pairs that were enrolled in the ENVIRONAGE birth cohort. Daily PM2.5 exposure levels were calculated for each mother's home address using a spatial-temporal interpolation model in combination with a dispersion model to estimate both long- (annual average before delivery) and short- (last month of pregnancy) term exposure. We explored the association between gene expression levels and PM2.5 exposure, and identified modulated pathways by overrepresentation analysis and gene set enrichment analysis.Results: Some processes were altered in both sexes for long- (e.g. DNA damage) or short-term exposure (e.g. olfactory signaling). For long-term exposure in boys neurodevelopment and RhoA pathways were modulated, while in girls defensin expression was down-regulated. For short-term exposure we identified pathways related to synaptic transmission and mitochondrial function (boys) and immune response (girls).Conclusions: This is the first whole genome gene expression study in cord blood to identify sex-specific pathways altered by PM2.5. The identified transcriptome pathways could provide new molecular insights as to the interaction pattern of early life PM2.5 exposure with the biological development of the fetus. [ABSTRACT FROM AUTHOR]

Background: Particulate matter (PM) exposure leads to premature death, mainly due to respiratory and cardiovascular diseases. Objectives: Identification of transcriptomic biomarkers of air pollution exposure and effect in a healthy adult population. Methods: Microarray analyses were performed in 98 healthy volunteers (48 men, 50 women). The expression of eight sex-specific candidate biomarker genes (significantly associated with PM[sub 10] in the discovery cohort and with a reported link to air pollution-related disease) was measured with qPCR in an independent validation cohort (75 men, 94 women). Pathway analysis was performed using Gene Set Enrichment Analysis. Average daily PM[sub 2.5] and PM[sub 10]exposures over 2-years were estimated for each participant's residential address using spatiotemporal interpolation in combination with a dispersion model. Results: Average long-term PM[sub 10] was 25.9 (± 5.4) and 23.7 (± 2.3) μg/m[sup 3] in the discovery and validation cohorts, respectively. In discovery analysis, associations between PM[sub 10] and the expression of individual genes differed by sex. In the validation cohort, long-term PM[sub 10] was associated with the expression of DNAJB5 and EAPP in men and ARHGAP4 (p = 0.053) in women. AKAP6 and LIMK1 were significantly associated with PM[sub 10] in women, although associations differed in direction between the discovery and validation cohorts. Expression of the eight candidate genes in the discovery cohort differentiated between validation cohort participants with high versus low PM[sub 10] exposure (area under the receiver operating curve = 0.92; 95% CI: 0.85, 1.00; p = 0.0002 in men, 0.86; 95% CI: 0.76, 0.96; p = 0.004 in women). Conclusions: Expression of the sex-specific candidate genes identified in the discovery population predicted PM[sub 10] exposure in an independent cohort of adults from the same area. Confirmation in other populations may further support this as a new approach for exposure assessment, and may contribute to the discovery of molecular mechanisms for PM-induced health effects. CITATION: Vrijens K, Winckelmans E, Tsamou M, Baeyens W, De Boever P, Jennen D, de Kok TM, Den Hond E, Lefebvre W, Plusquin M, Reynders H, Schoeters G, Van Larebeke N, Vanpoucke C, Kleinjans J, Nawrot TS. 2017. Sex-specific associations between particulate matter exposure and gene expression in independent discovery and validation cohorts of middle-aged men and women. Environ Health Perspect 125:660-669; http://dx.doi.org/10.1289/EHP370 [ABSTRACT FROM AUTHOR]

Objective: To explore the impact of a supervised implementation of an oral healthcare protocol, in addition to education, on nurses' and nurses' aides' oral health-related knowledge and attitude.Materials and Methods: A random sample of 12 nursing homes, accommodating a total of 120-150 residents, was obtained using stratified cluster sampling with replacement. The intervention included the implementation of an oral healthcare protocol and three different educational stages. One of the investigators supervised the implementation process, supported by a dental hygienist. A 34-item questionnaire was developed and validated to evaluate the knowledge and attitude of nurses and nurses' aides at baseline and 6 months after the start of the intervention. Linear mixed-model analyses were performed to explore differences in knowledge and attitude at 6 months after implementation.Results: At baseline, no significant differences were observed between the intervention and the control group for both knowledge (p = 0.42) and attitude (p = 0.37). Six months after the start of the intervention, significant differences were found between the intervention and the control group for the variable knowledge in favour of the intervention group (p < 0.0001) but not for the variable attitude (p = 0.78). Out of the mixed model with attitude as the dependent variable, it can be concluded that age (p = 0.031), educational level (p = 0.009) and ward type (p = 0.014) have a significant effect. The mixed model with knowledge as the dependent variable resulted in a significant effect of the intervention (p = 0.001) and the educational level (p = 0.009).Conclusion: The supervised implementation of an oral healthcare protocol significantly increased the knowledge of nurses and nurses' aides. In contrast, no significant improvements could be demonstrated in attitude. [ABSTRACT FROM AUTHOR]

When Belgium was overrun by Germany in 1914 neither the Belgian constitutional legislator, nor the Belgian legislator had determined how the police powers of the civil authorities could be transferred to the military authorities in the case of a war. Article 130 of the Constitution determined that the Constitution and the constitutional rights and freedoms it provided could never be suspended wholly or in part. This created a problem. There were several statutes which provided merely a limited answer for some situations. When Belgian military authorities instead of civil authorities took measures which invaded upon constitutional rights, disputes arose. In order to avoid these, the Belgian King enacted the decree-law concerning the state of war and the state of siege on 11 October 1916. Many provisions of this decree-law had been taken from the French war laws of 9 August 1849 and 4 April 1878, but -- contrary to these French laws -- the Belgian decree-law was not based on a formal constitutional stipulation. This decreelaw, which contravened the Belgian Constitution of 7 February 1831 and the fundamental rights and freedoms which were safeguarded by this Constitution in several respects, made it possible to take a number of measures during the state of war and the state of siege. As soon as these different provisions were applied, several citizens protested against them. Their protest was mainly aimed at the force of 'law' of the decree-law of 11 October 1916 and all of the other decree-laws. The rest of this contribution will detail when and why this protest took place, as well as how the Belgian administration of justice dealt with this protest. [ABSTRACT FROM AUTHOR]

Abstract: In a context where several sectors of society compete for space, land use types must be carefully designed and spatially allocated to guarantee a sufficient level of relevant ecosystem services (ES) in a territory of interest. In this respect, contemporary land use planning involves multiple, often conflicting objectives and criteria. Consequently, major benefits can be expected from spatial decision support systems (sDSS) designed to deal with complex spatial allocation problems. This paper presents the generic conceptual framework ‘OSMOSE’ and its free and open source software implementation, for the generation of specific sDSSs for spatial land use planning. The specific sDSSs generated with OSMOSE are meant to (i) identify land units which meet multiple predefined ES-attribute values for a specific land use type (LUT) and (ii) rank land units for a given LUT according to these multiple ES-attributes. A complementary purpose is to (i) identify and (ii) rank LUTs for a given land unit. Whereas ‘identification’ is done by means of a threshold query, ‘ranking’ is based on the Iterative Ideal Point Thresholding (IIPT) method. The proposed framework is extremely flexible as it can accommodate differentially weighted, continuous and/or ordinal attributes with, for the latter, equal or unequal number of classes, alternative land unit definitions and land use types. Moreover, assessments cannot only be made using ES-levels for the land unit/LUT combinations but also in terms of changes in ES-levels after a particular change of LUT. The OSMOSE framework is illustrated by means of the specific sDSS BoLa which is generated to support land use planning in the region of Flanders (Belgium) with focus on soil protection. Four cases are presented in which the decision support varies between the available approaches (threshold – selection, threshold – ranking, IIPT – selection, IIPT – ranking). [Copyright &y& Elsevier]

Objectives To evaluate the responsiveness of the Minimum Data Set inter RAI Acute Care ( AC), a comprehensive geriatric assessment system, to detect clinical changes in patient status during hospital stays. Design An explorative secondary data-analysis comparing prospectively collected data with the inter RAI AC before hospitalization, upon admission, and at discharge. Setting Clinicians from multiple disciplines in nine geriatric and eight nongeriatric wards of nine acute hospitals performed the assessment. Participants The inter RAI AC was administered serially to 256 geriatric inpatients (aged 83.2 ± 5.2; 60% female). Measurements Responsiveness (capacity to detect changes in patients) was calculated for the output scales on five domains: activities of daily living ( ADLs), cognition, communication, depressive symptoms, and pain. Internal responsiveness was evaluated using the Friedman test and Guyatt technique. Results Significant differences in clinical status were found for all five domains, based on the Friedman test. Post hoc tests revealed differences between each assessment period, except for cognition and communication from admission to discharge and for depressive symptoms from before admission to discharge. The Guyatt Responsiveness Index showed good to excellent capacity to detect longitudinal changes during hospitalization for cognition, communication, and pain and substantial performance for ADLs and depressive symptoms. Conclusion In older inpatients, fluctuations in ADLs, cognition, communication, depressive symptoms, and pain can be captured using the inter RAI AC output scales, enabling clinicians to evaluate longitudinal changes from admission to discharge and to provide a comparison with patient status before the acute onset of the illness. These results support the use of these scales in geriatric and nongeriatric wards. [ABSTRACT FROM AUTHOR]

Population ageing is affecting all Western countries. In order to cope with this challenge, governments focus mainly on ageing in place. Detection of frail or vulnerable older people becomes essential in order to provide appropriate support and prevent adverse outcomes. In this article we review the main paradigms on detecting frail or vulnerable older people living in the community, examine the theoretical gaps and develop new research possibilities. While there is increasing literature on frailty and vulnerability in later life, both concepts are still developing. The key question is: to what extent the actual concepts of frailty or vulnerability are appropriate to detect frail/vulnerable community dwelling older persons? The different concepts trying to capture frailty and vulnerability are criticized. Conclusively, the article highlights the need for a new integrated conceptual model for detecting community dwelling frail or vulnerable older persons including physical, psychological, social and environmental variables. [ABSTRACT FROM AUTHOR]

Aims and objectives. To provide insight into family caregiver perspectives on social relations within the 'caregiving triangle' between family caregiver, professional caregiver and elderly resident with dementia. Results were compared between traditional versus small-scale long-term care settings in the Netherlands and Belgium. Background. Residential dementia care is shifting towards a more holistic and person-centred approach. Until now, little is known about family caregiver perspectives. Design. A quasi-experimental longitudinal design. Methods. This study was part of a larger research project focusing on the quality of life of residents with dementia in traditional and small-scale settings ( n = 179). This study focused on family caregivers related to these residents ( n = 64). They filled in a questionnaire containing 25 items (baseline and after 12 months) related to their perspectives on the interaction within the 'caregiving triangle'. Analyses were performed using mixed models and logistic regression. Results. Compared to traditional settings, family caregivers of relatives with dementia living in small-scale settings had more contact with the professional caregivers, were more satisfied with this contact and felt that staff paid more attention to their feelings as family members. They also reported that staff showed better listening skills towards the residents. Furthermore, compared to those in Belgium, family caregivers in the Netherlands perceived staff to be less hurried and more accepting of help from family and felt that staff more often takes the resident seriously. Conclusion. In the move towards more person-centred care for residents with dementia, this study finds preliminary evidence for the importance of integrating the family perspective. Relevance to clinical practice. Gaining more insight into the perspectives of family caregivers on the social relations within the 'caregiving triangle' may provide knowledge about the importance of the social system surrounding elderly residents with dementia and can provide pointers for future research. [ABSTRACT FROM AUTHOR]

The article discusses the 20th anniversary conference of the Interdisciplinary Centre for Law and information and communication technologies (ICT) that was held in Leuven, Belgium on November 14-15, 2011. Brief information on presentations delivered at the conference is presented on topics including development of cloud computing, the issue of trustworthiness from the perspective of Archival Sciences and Diplomatics, and trust issues in the media and communications sectors.

doi: 10.1111/j.1741-2358.2010.00418.x Effect evaluation of a supervised versus non-supervised implementation of an oral health care guideline in nursing homes: a cluster randomised controlled clinical trial Objective: To compare a supervised versus a non-supervised implementation of an oral health care guideline in Flanders (Belgium). Background: The key factor in realising good oral health is daily oral hygiene care. In 2007, the Dutch guideline 'Oral health care in care homes for elderly people' was developed to improve oral health of institutionalised elderly. Materials and Methods: A random sample of 12 nursing homes was randomly allocated to the intervention or the control group. Representative samples of 30 residents in each home were monitored during a 6-month study period. The intervention included a supervised implementation of the guideline. Results: At the 6-month follow-up, only a small but statistically significant ( p = 0.002) beneficial effect (0.32) of the intervention was observed for denture plaque after adjustment for baseline value and the random effect of the institution. In the linear mixed regression models, including a random institution effect, difference in denture plaque level was no longer statistically significant at the 5% level. Conclusion: Only denture hygiene has been improved by the supervised implementation, although with lower benefits than presumed. Factors on institutional level, difficult to assess quantitatively, may play an important role in the final result. [ABSTRACT FROM AUTHOR]

This study provides an overview of 13 years of experience of preimplantation genetic diagnosis (PGD) for Huntington's disease (HD) at three European PGD centres in Brussels, Maastricht and Strasbourg. Information on all 331 PGD intakes for HD, couples' reproductive history, PGD approach, treatment cycles and outcomes between 1995 and 2008 were collected prospectively. Of 331 couples for intake, 68% requested direct testing and 32% exclusion testing (with a preponderance of French couples). At the time of PGD intake, 39% of women had experienced one or more pregnancies. A history of pregnancy termination after prenatal diagnosis was observed more frequently in the direct testing group (25%) than in the exclusion group (10%; P=0.0027). PGD workup was based on two approaches: (1) direct testing of the CAG-triplet repeat and (2) linkage analysis using intragenic or flanking microsatellite markers of the HTT gene. In total, 257 couples had started workup and 174 couples (70% direct testing, 30% exclusion testing) completed at least one PGD cycle. In total, 389 cycles continued to oocyte retrieval (OR). The delivery rates per OR were 19.8%, and per embryo transfer 24.8%, resulting in 77 deliveries and the birth of 90 children. We conclude that PGD is a valuable and safe reproductive option for HD carriers and couples at risk of transmitting HD. [ABSTRACT FROM AUTHOR]

Ergonomic sleep studies benefit from long-term monitoring in the home environment to cope with daily variations and habituation effects. Polysomnography allows to asses sleep accurately, but is costly, time-consuming and possibly disturbing for the sleeper. Actigraphy is cheap and user friendly, but for many studies lacks accuracy and detailed information. This proof-of-concept study investigates Least-Squares Support Vector Machines as a tool for automatic sleep stage classification (Wake-N1-Rem to N2-N3 separation), using automatic trainingset-specific filtered features as derived from three easy to register signals, namely heart rate, breathing rate and movement. The algorithms are trained and validated using 20 nights out of a 600 night database from over 100 different healthy persons. Different training and test set strategies were analyzed leading to different results. The more person-specific the training nights to the test nights, the better the classification accuracy as validated against the hypnograms scored by experts from the full polysomnograms. In the limit of complete person-specific training, the accuracy of the algorithm on the test set reached 94%. This means that this algorithm could serve its use in long-term monitoring sleep studies in the home environment, especially when prior person-specific polysomnographic training is performed. [ABSTRACT FROM AUTHOR]

The sleep system (i.e. the combination of mattress and bed base) is an important factor of the sleep environment since it allows physical recuperation during sleep by providing proper body support. However, various factors influence the interaction between the human body and the sleep system. Contributing factors include body dimensions, distribution of body weight and stiffness of the sleep system across the mattress surface. During the past decade, the rise of several new bedding technologies has made it increasingly difficult for the consumer to select a proper sleep system. Therefore, this study presents a method to model human-bed interaction in order to objectively predict the ideal sleep system for a particular individual. The proposed method combines a personalized anthropometric model with standardized load-deflection characteristics of mattress and bed base. Results for lateral sleep positions show a root mean square deviation of 11.9 ± 6.1 mm between modeled spine shapes and validation shapes, derived from 3D surface scans of the back surface. The method showed to be a reliable tool to individually identify the sleep system providing superior support from a variety of possible mattress-bed base combinations. [ABSTRACT FROM AUTHOR]

Almost six years after the first finding of the round goby Neogobius melanostomus (Gobiidae) in the Netherlands, several specimens of this invasive Ponto-Caspian benthic fish were also recorded in the Belgian part of the River Scheldt and in the Albert Canal. This is the first record of the round goby in Belgium. [ABSTRACT FROM AUTHOR]

Background: We hypothesized that in Flanders (Belgium), the prevalence of at-risk genotypes for genotoxic effects decreases with age due to morbidity and mortality resulting from chronic diseases. Rather than polymorphisms in single genes, the interaction of multiple genetic polymorphisms in low penetrance genes involved in genotoxic effects might be of relevance.Methods: Genotyping was performed on 399 randomly selected adults (aged 50-65) and on 442 randomly selected adolescents. Based on their involvement in processes relevant to genotoxicity, 28 low penetrance polymorphisms affecting the phenotype in 19 genes were selected (xenobiotic metabolism, oxidative stress defense and DNA repair, respectively 13, 6 and 9 polymorphisms). Polymorphisms which, based on available literature, could not clearly be categorized a priori as leading to an 'increased risk' or a 'protective effect' were excluded.Results: The mean number of risk alleles for all investigated polymorphisms was found to be lower in the 'elderly' (17.0 ± 2.9) than the 'adolescent' (17.6 ± 3.1) subpopulation (P = 0.002). These results were not affected by gender nor smoking. The prevalence of a high (> 17 = median) number of risk alleles was less frequent in the 'elderly' (40.6%) than the 'adolescent' (51.4%) subpopulation (P = 0.002). In particular for phase II enzymes, the mean number of risk alleles was lower in the 'elderly' (4.3 ± 1.6 ) than the 'adolescent' age group (4.8 ± 1.9) P < 0.001 and the prevalence of a high (> 4 = median) number of risk alleles was less frequent in the 'elderly' (41.3%) than the adolescent subpopulation (56.3%, P < 0.001). The prevalence of a high (> 8 = median) number of risk alleles for DNA repair enzyme-coding genes was lower in the 'elderly' (37,3%) than the 'adolescent' subpopulation (45.6%, P = 0.017).Conclusions: These observations are consistent with the hypothesis that, in Flanders, the prevalence of at-risk alleles in genes involved in genotoxic effects decreases with age, suggesting that persons carrying a higher number of at risk alleles (especially in phase II xenobiotic-metabolizing or DNA repair genes) are at a higher risk of morbidity and mortality from chronic diseases. Our findings also suggest that, regarding risk of disease associated with low penetrance polymorphisms, multiple polymorphisms should be taken into account, rather than single ones. [ABSTRACT FROM AUTHOR]

Abstract: The annual agricultural census in Belgium delivers quantitative data of net and additional areas of land used for agriculture and horticulture. We introduce the term ‘tare land’ to indicate the latter as the area of land fragments not directly supporting crops or fodder, at farm level or at higher (landscape, region) level. For spatial planning and zoning purposes data on gross agricultural area (being the sum of net and tare areas) are required. However, the quality of the tare data is not documented or even questioned. In Belgian and international scientific and grey literature, little information on tare is available. In this paper we define two classes of tare, functional tare (fTare) and plan tare (pTare). fTare encompasses the sum of the area of all additional land used by farmers for professional purpose or closely associated to the net agricultural area but not directly used for the production of food, fodder or industrial crops. Plan tare (pTare) is defined as these parts of the statutory agricultural area not specifically used in farming, such as public roads and inclusions of non-farming buildings. By means of a GPS-survey and interviews with farm managers, we used two methods to survey net and tare areas of land. On one hand we surveyed the land within farm enterprises: 3 open air horticultural farms, 6 greenhouse horticultural farms and one mixed farm (open air horticulture and greenhouse). On the other hand we surveyed 10 segments of 25ha, all situated in one municipality within a major horticultural region of Flanders (northern region of Belgium). fTare areas account on average for 21% of the total farm area in the case of open air horticulture whereas the fTare area is 39% in case of greenhouse horticultural farms. These averages are significantly different. The mixed farm had an fTare area of 32%. Within areas designated for agriculture plan tare is 44%. Hence only 56% of the land with an agricultural destination is effectively used for agriculture. These figures illustrate the spatial importance of tare areas and the spatially extremely scattered organisation of horticulture in the study area. Knowledge on quality and nature of tare areas is important for multi-objective spatial planning in which economic and ecological sustainability of agriculture is considered. [Copyright &y& Elsevier]

Abstract: The paper describes the results of a research that aimed to come up with a well structured method to estimate future farmland requirements in densely populated areas. By using in depth interviews, scenario analysis and strategic orientation rounds, a method is developed to support policy optimization and to explore alternative future developments. The method is applied to the case of agriculture in the Flemish part of Belgium to show the feasibility of the model and to provide input for the discussion among policy makers in Flanders. The research results can be used by policy makers to build a new Spatial Plan Flanders for the period 2007–2013. [Copyright &y& Elsevier]

Abstract: At the University Hospital of Pellenberg (Belgium), more than 1000 patients have been treated with Botulinum toxin type A (BTX-A) over the last decade. Ten percent of these patients (n =106) received multiple (at least four times), multi-level, high-dosage treatments. The aim of this study was to evaluate the stability of dosage and treatment intervals in long-term, multi-level, high-dosage treated children with cerebral palsy and to evaluate the evidence for a safe and stable response to this treatment. Data on disease, age, dosage and target muscles were extracted for each treatment session of 106 patients who received multiple BTX-A treatment sessions. Patients had a follow-up of 4y 6mo (range 1y 8mo–8y 9mo) on average and received 4 to 12 BTX-A treatments within the period of January 1996 and December 2005. Patients received a mean dosage of 23.5±5.2U/kgbw at first treatment with stable subsequent values. Mean dosages for children with diplegia, hemiplegia and quadriplegia were 24.5±4.7U/kgbw, 15.9±3.7U/kgbw and 22.0±4.8U/kgbw, respectively. Mean age at first treatment was 4y 6mo (range 1y 11mo–18y 10mo) with a majority of patients (76.4%) first treated within 2 and 4y of age. Treatment intervals of approximately 1y remained stable within four, five and six subsequent treatments. Long-term, high-dosage, multi-level BTX-A applications can be considered as a safe and stable treatment option for children with cerebral palsy and the formation of antibodies, responsible for secondary non-response, can be indirectly precluded. [Copyright &y& Elsevier]

Purpose: To estimate the rotation stability of the bag-in-the-lens (BIL) intraocular lens (IOL) (Morcher 89A) over time and to assess whether the rotational stability of the IOL design is suitable for toric corrections. Setting: Department of Ophthalmology, Antwerp University Hospital, Edegem, Belgium. Methods: This prospective study evaluated patients who had cataract surgery and BIL IOL implantation. Postoperative red reflex photographs were taken 1 day, 5 weeks, and 6 months after surgery. Intraocular lens rotation was obtained by defining a triangle between a scleral blood vessel, the IOL haptic, and the IOL optic center. Changes in the triangle during the follow-up were evaluated using purpose-designed software written in MatLab. Results: Fifty-nine eyes of 49 patients (mean age 68.0 years ± 11.9 [SD]) were included. There was little postoperative IOL rotation (mean 0.05 ± 2.02 degrees) between 1 day and 5 weeks (n = 46 eyes) and between 5 weeks and 6 months (mean 0.36 ± 1.39 degrees) (n = 15 eyes). The IOL rotation remained unchanged from 1 to 6 months postoperatively (P = .327, analysis of variance). There was no correlation between IOL rotation and patient age (r 2 = 0.011) or IOL power (r 2 = 0.003). Postoperative IOL rotations were not different between left eyes and right eyes (P = .862, t test). Conclusion: The BIL IOL showed good rotation stability, making it suitable for toric correction. [Copyright &y& Elsevier]

In order to provide a basis for quantitative and qualitative assessment of SDI-performance, a clear definition and a theoretical framework for SDI are needed. From the various definitions and frameworks of SDI available in the literature, the productional and the geographic information process perspective were selected, combined and extended. From the productional perspective, SDI-development is a dynamic process in which suppliers and users of spatial data interact to add value to the data by using them in applications and processes. The geographic information process perspective incorporates the “information acquisition – delivery – usage” chain. The extension proposed in this article leads to a network perspective on SDI. The nature of this perspective is described for the Flemish SDI. Its applicability to characterise and underpin the assessment of SDI is tested using a Social Network Analysis (SNA) focusing on the network structure parameters “density”, “distance” and “centrality”. The SNA confirms the applicability, usability and extensibility of the network perspective to characterize the SDI, to describe the data flows between stakeholders and to analyse the behaviour of the different (types) of stakeholders within the network. We conclude that SNA should likely be complemented by an impact analysis of different SDI setups on business processes which will provide a good basis for a holistic SDI-performance assessment. [ABSTRACT FROM AUTHOR]

Belgian politicians submitted a proposal to rescind the law on anonymity of organ donation and transplantation and facilitate contact between donor families and recipients. It remains uncertain if recipients support this proposal. Methodology: One liver transplant patient organization (n = 176/249) answered and provided comments on two questions: (i) how satisfied are you with the current principle of anonymity of the identity of the donor and (ii) the law about anonymity should be changed to allow the donor family and the patient to meet. Results: Seventy percent were satisfied/very satisfied with the present law, because of anxiety for emotional involvement or feeling obliged to do something in return, feelings of guilt, and out of mutual respect. Nineteen percent was dissatisfied/very dissatisfied and want to obtain some information about the donor, and directly express their gratitude. Forty-two percent disagreed with a change, because of anxiety for manipulation, feelings of guilt, respect for the privacy, and worry about the donor having a different background. Thirty-six percent wanted to change the law out of curiosity, to express their gratitude, or to facilitate their coping process. Discussion: Prudence to change the law is warranted, as only a minority of patients are in favor of rescinding the anonymity. [ABSTRACT FROM AUTHOR]

Because the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) differs among the 3 countries forming the Euregio Meuse-Rhin (EMR) region (Belgium, Germany, and the Netherlands), cross-border healthcare requires information about the spread of MRSA in the EMR. We investigated the emergence, dissemination, and diversity of MRSA clones in the EMR by using several typing methods. MRSA associated with clonal complexes 5, 8, 30, and 45 was disseminated throughout the EMR. Dutch isolates, mainly associated with sequence types (ST) ST5-MRSA-II, ST5-MRSA-IV, ST8-MRSA-IV, and ST45-MSRAIV had a more diverse genetic background than the isolates from Belgium and Germany, associated with ST45-MRSAIV and ST5-MRSA-II, respectively. MRSA associated with pigs (ST398-MRSA-IV/V) was found in the Dutch area of the EMR. Five percent of the MRSA isolates harbored Panton-Valentine leukocidin and were classified as communityassociated MRSA associated with ST1, 8, 30, 80, and 89. [ABSTRACT FROM AUTHOR]

Abstract: Global time series of low resolution images are available with high repeat frequency and at low cost, but their analysis is hampered by the presence of mixed pixels and the difficulty in locating detailed spatial features. This study examined the potential of sub-pixel classification for regional crop area estimation using time series of monthly NDVI-composites of the 1km resolution sensor SPOT-VEGETATION. Belgium was selected as test zone, because of the availability of ample reference data in the form of a vectorial GIS with the boundaries and cover type of the large majority of agricultural fields. Two different methods were investigated: the linear mixture model and neural networks. Both result in area fraction images (AFIs), which contain for each 1km pixel the estimated area proportions occupied by the different cover types (crops or other land use). Both algorithms were trained with part of the reference data and validated with the remainder. Validation was repeated at three different levels: the 1km pixel, the municipality and the agro-statistical district. In general, the neural network outperformed the linear mixture model. For the major classes (winter wheat, maize, forest) the obtained acreage estimates showed good agreement with the true values, especially when aggregated to the level of the municipality (R 2 ≈85%) or district (R 2 ≈95%). The method seems attractive for wide-scale, regional area estimation in data-poor countries. [Copyright &y& Elsevier]

In the debate on 'flexicurity', relatively little attention has been paid to how responsive traditional areas of social security have been to increasing flexibility in the labour market. This article tries to fill this gap by focusing on the Belgian pension system. In particular, it asks to what extent pension regulation in the three pillars has been adapted to the proliferation of atypical forms of employment. It does so by examining whether there are significant differences between old age protection of standard and non-standard workers. The article pursues a double research strategy: an analysis of Belgian legislation and relevant collective labour agreements is complemented with a statistical analysis of the Panel Study of Belgian Households (PSBH). The results show that part-time employment results in a lower first-pillar pension, while other forms of temporal flexibility such as career interruptions and temporary unemployment do not. In the second pillar, our findings suggest that workers with contractual flexibility and job mobility are discriminated against. Finally, non-standard workers do not appear to compensate for lower pension protection through increased participation in the third pension pillar. Our findings suggest the need for a re-assessment of the system of 'assimilated' periods. To conclude, we point to some implications for the design of flexicurity policies. [ABSTRACT FROM AUTHOR]

The present study quantifies changes in soil organic carbon (SOC) stocks in Belgium between 1960, 1990 and 2000 for 289 spatially explicit land units with unique soil association and land-use type, termed landscape units (LSU). The SOC stocks are derived from multiple nonstandardized sets of field measurements up to a depth of 30 cm. Approximately half of the LSU show an increase in SOC between 1960 and 2000. The significant increases occur mainly in soils of grassland LSU in northern Belgium. Significant decreases are observed on loamy cropland soils. Although the largest SOC gains are observed for LSU under forest (22 t C ha−1 for coniferous and 29 t C ha−1 for broadleaf and mixed forest in the upper 30 cm of soil), significant changes are rare because of large variability. Because the number of available measurements is very high for agricultural land, most significant changes occur under cropland and grassland, but the corresponding average SOC change is smaller than for forests (9 t C ha−1 increase for grassland and 1 t C ha−1 decrease for cropland). The 1990 data for agricultural LSU show that the SOC changes between 1960 and 2000 are not linear. Most agricultural LSU show a higher SOC stock in 1990 than in 2000, especially in northern Belgium. The observed temporal and spatial patterns can be explained by a change in manure application intensity. SOC stock changes caused by land-use change are estimated. The SOC change over time is derived from observed differences between SOC stocks in space. Because SOC stocks are continuously influenced by a number of external factors, mainly land-use history and current land management and climate, this approach gives only an approximate estimate whose validity is limited to these conditions. [ABSTRACT FROM AUTHOR]

This paper reports the results of a normative study of the 60-item version of the Boston Naming Test (BNT) in a group of 371 native Dutch-speaking Flemish children between the ages of 6 and 12 years. Analysis of test results revealed that BNT performance was significantly affected by age and gender. The gathered norms were shown to be significantly lower than published norms for comparable North-American children. Error analysis disclosed remarkable similarities with data from elderly subjects, with verbal semantic paraphasias and 'don't know' responses occurring most frequently. Finally, BNT scores were shown to correlate strongly with general intelligence as measured with the Raven Progressive Matrices. The relation between both measures can be of help in the diagnosis of identification naming deficits and impaired word-retrieval capacities. [ABSTRACT FROM AUTHOR]