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Background: Evidence-based recommendations for a core outcome set (COS; minimum set of outcomes) for aphasia treatment research have been developed (the Research Outcome Measurement in Aphasia--ROMA, COS). Five recommended core outcome constructs: communication, language, quality of life, emotional well-being and patient-reported satisfaction/impact of treatment, were identified through three international consensus studies. Constructs were paired with outcome measurement instruments (OMIs) during an international consensus meeting (ROMA-1). Before the current study (ROMA-2), agreement had not been reached on OMIs for the constructs of communication or patient-reported satisfaction/impact of treatment. Aim: To establish consensus on a communication OMI for inclusion in the ROMA COS. Methods & Procedures: Research methods were based on recommendations from the Core Outcome Measures in Effectiveness Trials (COMET) Initiative. Participants with expertise in design and conduct of aphasia trials, measurement instrument development/testing and/or communication outcome measurement were recruited through an open call. Before the consensus meeting, participants agreed on a definition of communication, identified appropriate OMIs, extracted their measurement properties and established criteria for their quality assessment. During the consensus meeting they short-listed OMIs and participants without conflicts of interest voted on the two most highly ranked instruments. Consensus was defined a priori as agreement by [greater than or equal to] 70% of participants. Outcomes & Results: In total, 40 researchers from nine countries participated in ROMA-2 (including four facilitators and three-panel members who participated in pre-meeting activities only). A total of 20 OMIs were identified and evaluated. Eight short-listed communication measures were further evaluated for their measurement properties and ranked. Participants in the consensus meeting (n = 33) who did not have conflicts of interest (n = 29) voted on the top two ranked OMIs: The Scenario Test (TST) and the Communication Activities of Daily Living--3 (CADL-3). TST received 72% (n = 21) of 'yes' votes and the CADL-3 received 28% (n = 8) of 'yes' votes. Conclusions & Implications: Consensus was achieved that TST was the preferred communication OMI for inclusion in the ROMA COS. It is currently available in the original Dutch version and has been adapted into English, German and Greek. Further consideration must be given to the best way to measure communication in people with mild aphasia. Development of a patient-reported measure for satisfaction with/impact of treatment and multilingual versions of all OMIs of the COS is still required. Implementation of the ROMA COS would improve research outcome measurement and the quality, relevance, transparency, replicability and efficiency of aphasia treatment research.

Background: In this paper, we investigate the predictors for enrollment and success in Science, Technology, Engineering, and Mathematics (STEM) programs in higher education. We develop a sequential logit model in which students enroll in STEM education, may drop out from STEM higher education, or continue studying until they graduate in an STEM field. We use rich Dutch register data on student characteristics and high school exam grades to explain the differences in enrollment, success, and dropout rates. Results: We find that females are less likely to enroll in STEM-related fields, while students with higher high school mathematics grades are more likely to enroll in STEM. Female students have lower first-year dropout rates at university of applied sciences STEM programs. With respect to study success, we find that conditional on enrollment in STEM, women are less likely to graduate than men within the nominal duration or the nominal duration plus one additional year. However, female students do perform equally well as male students in terms of graduation within 10 years. Conclusions: We conclude that STEM programs are less popular among female students and that female students are less likely to graduate on time. However, females perform equally well in STEM higher education in the long run. For this reason, policy should be geared at increasing study success in terms of nominal graduation rates among female STEM students.

This paper reviews studies on diversity in higher education institutions and suggests empirical approaches to measure diversity. "Diversity" in this paper refers to the internal and external differences among academic programs and institutions. As the empirical literature is relatively salient about how to measure diversity in higher education, the study suggests and compares the use of the Herfindhal index, Gini coefficient, Theil entropy index and the Birnbaum (1983) measure. Applying the indices to data on Dutch higher education, the results indicate limited diversity between institutions, disciplines, and bachelor's programs. The diversity at the master's program and first year bachelor's program levels increased between 2008 and 2013.

Using a framework for educational design research, this article reports and evaluates the (process of the) design of a financial education program. The program is designed for high school students in the prevocational track in the Netherlands. The aim of the program is to improve students' financial knowledge, attitudes, self-efficacy, and (savings) behavior. The main outcome of this study is the identification of design principles that can be used by others for the design of financial education programs: setting a personal savings goal, commitment with and reflection on this goal, discussing money issues with peers and family, hands-on activities with autonomy, and explicit instruction through animated video clips. The results show that our program, called "SaveWise," improves high school students' financial knowledge and skills, financial awareness, attitudes towards money, self-efficacy, and financial behavior.

Higher education institutions have experienced an increase in student enrolment over the past decades. At the same time, universities increasingly attempt to attract students by offering a variety of study programmes. Using a Dutch panel data set of 1300 programmes in 50 institutions, this study investigates what explains the attractiveness of study programmes. We hypothesize that the distance of study programmes plays a major role in student decisions to attend. Based on an instrumental variables identification strategy, we demonstrate that the closest distance between similar programmes offered and competition between programmes have significant effects on the enrolment of students in higher education. The results indicate that a one-kilometer increase in the closest distance between similar programmes decreases the number of students to enrol in a programme by seven students after controlling for programme type and other characteristics.

This article examines an educational experiment with a unique combination of 3 elements: homework, the use of information and communication technology and a large degree of freedom of choice (student autonomy). More particularly, we study the effectiveness of a web-based intelligent tutoring system (ITS) that a school offers to its students as optional homework, in a sample of 355 first-year secondary students, using an experimental design. The results show that whether students make this noncompulsory homework in the web-based ITS is dependent on their prior achievement and their teacher, and if they practice, they tend to choose easier modules. Students thus do not seem to optimize learning gains, but rather balance their perceived value of practicing and their "expectancy," as found previously for regular (compulsory, non-ITS) homework. Regarding the value of choice, findings suggest that students may be poor judges of their most beneficial exercises pattern. Differentiation in ITS does not guarantee learning, unless scaffolding is tightly linked to it. In line with previous research, this research shows that practice does matter, though at varying intensities. Yet it also clarifies that motivation to make an effort is required, which adds to the lessons learned from homework research; both the perceived value and expectancy are at play and can be enhanced, for example, by teachers.

Autism spectrum disorder and attention deficit/hyperactivity disorder overlap in several ways, raising questions about the nature of this comorbidity. Rommelse et al. published an innovative review of candidate endophenotypes for autism spectrum disorder and attention deficit/hyperactivity disorder in cognitive and brain domains. They found that all the endophenotypic impairments that were reviewed in attention deficit/hyperactivity disorder were also present in autism spectrum disorder, suggesting a continuity model with attention deficit/hyperactivity disorder as "a light form of autism spectrum disorder." Using existing data, 75 adults with autism spectrum disorder and 53 with attention deficit/hyperactivity disorder were directly compared on autistic symptoms with the autism spectrum quotient, and on the endophenotypic measure of temperament and character, using the Abbreviated (Dutch: Verkorte) Temperament and Character Inventory. Based on the hypothesis that attention deficit/hyperactivity disorder and autism spectrum disorder are disorders on a continuous spectrum, autism spectrum quotient scores and abbreviated Temperament and Character Inventory scores were expected to be different from normal controls in both disorders in a similar direction. In addition, the autism spectrum quotient and abbreviated Temperament and Character Inventory scores were expected to be closely correlated. These conditions applied to only two of the seven Abbreviated Temperament and Character Inventory scales (harm avoidance and self-directedness), suggesting that temperament and character as an endophenotype of autism spectrum disorder and attention deficit/hyperactivity disorder provides only partial support for the continuity hypothesis of autism spectrum disorder and attention deficit/hyperactivity disorder.

Secondary school pupils underachieve in tests in which reasoning abilities are required. Brain-based training of working memory (WM) may improve reasoning abilities. In this study, we use a brain-based training programme based on historical content to enhance reasoning abilities in history courses. In the first experiment, a combined intervention of WM-capacity and reasoning strategies is trained and compared with control group data in "HAVO" (medium track secondary education in the Netherlands). WM-capacity and reasoning strategies of the experimental group improve significantly after three weeks of training. Students achieve significantly better in school tests in which reasoning abilities are tested. The gain in reasoning abilities is also significant 16 weeks after the training programme is completed. In the second experiment, WM-capacity and reasoning strategies are trained independently and compared with control group data in "VWO" (upper track secondary education). Training of WM-capacity did not improve achievements in reasoning tests significantly, but training of reasoning strategies did. However, the results of both experiments cannot be compared because of cognitive group differences between Experiment 1 and 2 (educational tracks). These results demonstrate that brain-based learning strategies to improve reasoning abilities can easily be integrated in history curricula. Furthermore, a six-week training period can improve reasoning abilities of students in secondary education significantly. The study used content-based, non-adaptive training methods that are based on standardised tests. Cognitive WM test scores indicate a ceiling effect which can be explained by the absence of the adaptive element in the training.

Community schools are becoming increasingly popular. They aim to enhance children's educational performance by offering extended educational and social services. As community schools mainly focus on disadvantaged children, this study evaluates the effects of community schooling on the educational outcomes of these pupils. We focus on care pupils and pupils whose parents have a low educational attainment. We hypothesize that community schools are particularly beneficial to care pupils, namely, pupils with additional educational needs, and for pupils with parents with lower levels of educational attainment. Our analyses show that both pupil groups benefit in terms of reduced underachievement. The duration of community school attendance as such does not affect cognitive outcomes, but it proves beneficial to the educational achievement of both groups when the community school subsidy is taken into account as well. We show that different community school activities have partly contrary effects on care pupils and non-care pupils.

Many children with specific language impairment (SLI) show impairments in discriminating auditorily presented stimuli. The present study investigates whether these discrimination problems are speech specific or of a general auditory nature. This was studied using a linguistic and nonlinguistic contrast that were matched for acoustic complexity in an active behavioral task and a passive ERP paradigm, known to elicit the mismatch negativity (MMN). In addition, attention skills and a variety of language skills were measured. Participants were 25 five-year-old Dutch children with SLI having receptive as well as productive language problems and 25 control children with typical speech- and language development. At the behavioral level, the SLI group was impaired in discriminating the linguistic contrast as compared to the control group, while both groups were unable to distinguish the non-linguistic contrast. Moreover, the SLI group tended to have impaired attention skills which correlated with performance on most of the language tests. At the neural level, the SLI group, in contrast to the control group, did not show an MMN in response to either the linguistic or nonlinguistic contrast. The MMN data are consistent with an account that relates the symptoms in children with SLI to non-speech processing difficulties. (Contains 3 tables and 4 figures.)

Previous studies have suggested toxic effects of recreational ecstasy use on the serotonin system of the brain. However, it cannot be excluded that observed differences between users and non-users are the cause rather than the consequence of ecstasy use. As part of the Netherlands XTC Toxicity (NeXT) study, we prospectively assessed sustained effects of ecstasy use on the brain in novel ecstasy users using repeated measurements with a combination of different neuroimaging parameters of neurotoxicity. At baseline, 188 ecstasy-naive volunteers with high probability of first ecstasy use were examined. After a mean period of 17 months follow-up, neuroimaging was repeated in 59 incident ecstasy users and 56 matched persistent ecstasy-naives and their outcomes were compared. Neuroimaging included [[superscript 123]I]Beta-carbomethoxy-3Beta-(4-iodophenyl)tropane (CIT) SPECT to measure serotonin transporter densities as indicators of serotonergic function; [superscript 1]H-MR spectroscopy ([superscript 1]H-MRS) to measure brain metabolites as indicators of neuronal damage; diffusion tensor imaging (DTI) to measure the apparent diffusion coefficient and fractional anisotropy (FA) of the diffusional motion of water molecules in the brain as indicators of axonal integrity; and perfusion weighted imaging (PWI) to measure regional relative cerebral blood volume (rrCBV) which indicates brain perfusion. With this approach, both structural ([superscript 1]H-MRS and DTI) and functional ([[superscript 123]I]Beta-CIT SPECT and PWI) aspects of neurotoxicity were combined. Compared to persistent ecstasy-naives, novel low-dose ecstasy users (mean 6.0, median 2.0 tablets) showed decreased rrCBV in the globus pallidus and putamen; decreased FA in thalamus and frontoparietal white matter; increased FA in globus pallidus; and increased apparent diffusion coefficient in the thalamus. No changes in serotonin transporter densities and brain metabolites were observed. These findings suggest sustained effects of ecstasy on brain microvasculature, white matter maturation and possibly axonal damage due to low dosages of ecstasy. Although we do not know yet whether these effects are reversible or not, we cannot exclude that ecstasy even in low doses is neurotoxic to the brain.

Our aim is to identify predictors of first-time ecstasy use in a prospective study among young people at risk. As part of the multidisciplinary Netherlands XTC Toxicity Study (NeXT), we monitored 188 subjects aged up to 18 years who were ecstasy-naive at baseline but seemed likely to start taking ecstasy in the near future. After an 11- to 26-month follow-up period, 160 respondents remained (85.1%; mean age 21.0 years, 58.1% females): 65 who took ecstasy at least once (ecstasy users) and 95 non-users. At baseline and four times during follow-up, respondents completed self-report questionnaires. Cox regression analysis was used to examine the effects of baseline respondent characteristics on incident ecstasy use. Development of peer group ecstasy use was analyzed by logistic regression. Intention to use ecstasy, low education, and current weekly cannabis use independently increased the hazard rate for first ecstasy use. Although ecstasy use among peers at baseline was not a predictor, the proportion of ecstasy users with ecstasy-using peers increased markedly during the study. Our results suggest that targeted prevention activities should focus in particular on young people who have strong intentions to take ecstasy, especially if they are also regular smokers of cannabis. (Contains 2 tables and 1 figure.)

Societal changes demand educators to apply new pedagogical approaches. Many educational stakeholders feel that serious games could play a key role in fulfilling this demand, and they lick their chops when looking at the booming industry of leisure games. However, current toolkits for developing leisure games show severe shortcomings when applied to serious games. Developing effective serious games in an efficient way requires a specific approach and tool set. This article describes the EMERGO methodology and generic toolkit for developing and delivering scenario-based serious games that are aimed at the acquisition of complex cognitive skills in higher education. Preliminary evaluation results with case developers using the EMERGO methodology and toolkit and with learners using EMERGO cases are presented. (Contains 4 figures and 5 tables.)

This paper analyses the relation between two important aspects of human capital: education and health. The contribution of our paper to the literature is three-fold: some further tests for causality in the relation between education and health are provided; it is tested whether results are affected by scale of reference bias and unobserved heterogeneity; and the results are used to calculate the health returns to education. We use data from a large survey for the Netherlands to estimate the education effects on health. Calculated at the average value of GDP per capita, the implied health returns to education are 1.3-5.8%. We further test for causality in the relation between education and health and for the effects of scale of reference bias and unobserved heterogeneity. None of these appear to affect our conclusions.

The structural relationships between body mass index, perceived health and happiness have been studied in a survey of 700 native Dutch citizens. We found an indirect effect of body mass index on happiness, via perceived health. Age had an inverted U-shaped relationship with body mass index, and both education and smoking had a negative effect on body mass index. Being married, doing paid work, owning a house, and doing sports had positive effects on perceived health, suggesting that living a regular life may lead to a better perceived health. Being married positively affected happiness. The other socio-demographic variables either had no effects on happiness or indirect effects via body mass index and perceived health.

In evaluating family preservation services, it is important not only to study the service outcomes and the family characteristics, but also what actually happens during the treatment. This requires a program model. This article describes how a program model works, prescribes how workers should carry it out, and describes how researchers should measure the program's characteristics. The authors use data from Families First in The Netherlands to test the model. Results show that the method of the program meets the specified characteristics. The results are important for treatment, policy, education, and evaluation research.

Objective: To determine the prevalence of psychiatric disorders among incarcerated male adolescents and to investigate the influence of psychopathology on allocation to either plain detention or detention with compulsory treatment. Method: A cross-sectional study of a representative sample (N = 204) of incarcerated boys aged 12 to 18, using the Diagnostic Interview Schedule for Children (DISC). Data were collected from December 1998 to December 1999. Results: Of the eligible subjects, 79% agreed to participate. Ninety percent reported at least one psychiatric disorder: disruptive behavior disorder 75% (95% confidence interval [CI]: 68-81%), substance use disorder 55% (95% CI: 48-63%), psychotic symptoms 34% (95% CI: 27-41%), ADHD 8% (95% CI: 5-13%), anxiety disorder 9% (95% CI: 6-15%), and affective disorder 6% (95% CI: 3-10%). After controlling for a broad range of sociodemographic characteristics and former treatment parameters, the presence of a psychiatric disorder was not associated with allocation to compulsory treatment. Conclusions: Compared with North American studies, relatively low rates of anxiety and affective disorders were found, probably due to the better availability of mental health services to disadvantaged youths with internalizing problems in the Netherlands. It should be examined whether standardized psychiatric assessments can improve the efficiency of allocation to detention programs with or without psychiatric treatment options.

A random effects ordered response model of training is estimated to analyze the existence of training tracks and time varying coefficients in training frequency. Two waves of a Dutch panel survey of workers are used covering the period 1992-1996. The amount of training received by workers increased during the period 1994-1996 compared to 1992-1994. Evidence is found for the existence of training tracks in the amount of training courses taken. It is further found that the effects of individual characteristics such as education, age and gender on training should be treated as individual varying coefficients.

Dutch human-resources professionals (n=161) identified trends affecting the future of human-resource development. Compared to a U.S. study by the American Society for Training and Development, Dutch professionals rated the following most important: integration of learning and work, importance of organizational innovation, and measurement of business results using consumer-relevant criteria. (SK)

In the recent past, we have seen a parting of the ways of the theological discipline and public universities in many places throughout Western Europe. In this article, firstly, some backgrounds of this development are briefly explored, taking the situation in the Netherlands as an example. Secondly, it is argued that from a Christian – and especially a Reformed – theological point of view that this development is suboptimal and should be regretted. Thirdly, two lines of argument for retaining a place for theology at public and largely secular contemporary universities are investigated: the first one, which attempts to align theology to the natural sciences, is found wanting; the second one, which situates theology in the realm of the humanities, is argued to be largely convincing. Following this finding, a case study was offered of how a theological faculty or department could be (re)structured in such a way that – without turning it into an allegedly 'neutral' religious studies department – it continues to occupy a viable place within contemporary public universities. It is argued that theological faculties might have to open up to a variety of religious perspectives (rather than hosting just one religious tradition) both for epistemic and political reasons. Finally, a brief suggestion was made as to how such a development might be justified from a Reformed theological perspective. [ABSTRACT FROM AUTHOR]

Antibiotics are a contaminant class of worldwide concern as they are frequently detected in aquatic ecosystems. To better understand the impacts of antibiotics on aquatic ecosystems, we conducted an outdoor mesocosm experiment in which aquatic communities were exposed to different concentrations of the antibiotic sulfamethoxazole (0, 0.15, 1.5, 15 and 150 μg/L). These concentrations include mean (0.15 μg/L) and maximum detected concentrations (15 and 150 μg/L) in aquatic ecosystems worldwide. Sulfamethoxazole was applied once a week for eight consecutive weeks to 1530 L outdoor mesocosms in the Netherlands, followed by an eight-week recovery period. We evaluated phytoplankton-, bacterial- and invertebrate responses during and after sulfamethoxazole exposure and assessed impacts on organic matter decomposition. Contrary to our expectations, consistent treatment-related effects on algal and bacterial communities could not be demonstrated. In addition, sulfamethoxazole did not significantly affect zooplankton and macroinvertebrate communities. However, some effects on specific taxa were observed, with an increase in Mesostoma flatworm abundance (NOEC of <0.15 μg/L). In addition, eDNA analyses indicated negative impacts on the insects Odonata at a sulfamethoxazole concentration of 15 μg/L. Overall, environmentally relevant sulfamethoxazole concentration did not result in direct or indirect impairment of entire aquatic communities and ecological processes in our mesocosms. However, several specific macroinvertebrate taxa demonstrated significant (in)direct effects from sulfamethoxazole. Comparison of the results with the literature showed inconsistent results between studies using comparable, environmentally relevant, concentrations. Therefore, our study highlights the importance of testing the ecological impacts of pharmaceuticals (such as sulfamethoxazole) across multiple trophic levels spanning multiple aquatic communities, to fully understand its potential ecological threats. [Display omitted] • Environmentally relevant concentrations did not impair aquatic communities. • Combining DNA tools and morphological identification provided complementary information. • We observed inconsistent results between studies using comparable concentrations. [ABSTRACT FROM AUTHOR]

Introduction: The standard aftercare treatment (according to the AO guideline) for surgically treated trauma patients with fractures of the tibial plateau is non-weight bearing or partial weight bearing for 10-12 weeks. The purpose of this study was to investigate the current state of practice among orthopaedic surgeons and trauma surgeons in choosing the criteria and the time period of restricted weight bearing after surgically treated tibial plateau fractures.Materials and Methods: A web-based survey was distributed among members of the Dutch Trauma Society and Dutch Orthopaedic Society to identify the most commonly applied protocols in terms of the post-operative initiation and level of weight bearing in patients with tibial plateau fractures.Results: One hundred and eleven surgeons responded to the survey. 72.1% of the respondents recommended starting weight bearing earlier than the 12 weeks recommended by the AO guideline; 11.7% recommended starting weight bearing immediately, 4.5% after 2 weeks and 55.9% after 6 weeks. Moreover, 88.7% of the respondents reported deviating from their own local protocol. There is little consensus about the definition of 100% weight bearing and how to build up weight bearing over time.Conclusion: This study demonstrates that consensus about the weight bearing aftercare for tibial plateau fractures are limited. A large majority of surgeons do not follow the AO guideline or their own local protocol. More transparent criteria and predictors are needed to design optimal weight-bearing regimes for the aftercare of tibial plateau fractures. [ABSTRACT FROM AUTHOR]

Purpose: We sought to determine whether the introduction of a separate patient flow comprising patients with simple, non-complex health issues [Fast Track (FT)] in a Dutch emergency department setting (ED), without the introduction of additional staff, and treated by a physician assistant, would have favourable effects on waiting and turnaround times without deleterious effects for patients with a higher urgency. Study design: We used a prospective comparative intervention design for our study. Methods: The waiting times and length of stay for surgical and orthopaedic patients in the ED were measured and compared 3 months before and 3 months after the introduction of FT. Results: During the study period, 1,289 patients were treated before, and 1,393 after the introduction of FT. After the introduction of FT, we observed a decrease of 12 min (13 %) in the median length of stay for the total group. The median waiting time decreased by 41 min (69 %). The group comprising patients with low to moderate urgency levels showed a median reduction of 12 min in length of stay, whereas the length of stay for urgent patients was reduced by 19 min. The waiting time for the low to moderate urgency patients decreased by 68 min, while the urgent patient group showed a reduction of 32 min. Conclusions: The introduction of FT performed by a physician assistant resulted in a significant drop in waiting time and length of stay in a Dutch ED setting. This reduction was realised without the allocation of additional staff and even reduced waiting and turnaround times for the patients with a high urgency. [ABSTRACT FROM AUTHOR]

Introduction and purpose: The controversy between the 'scoop and run' versus the 'stay and play' approach in severely injured trauma patients has been an ongoing issue for decades. The present study was undertaken to investigate whether changes in prehospital care for patients with severe traumatic brain injury in the Netherlands have improved outcome. Methods: In this retrospective study, files ( n = 60) were analyzed from a prospectively collected database including all patients admitted to one of six hospitals in the Limburg region in the Netherlands with a Glasgow Coma Scale (GCS) score ≤8 on admittance over the period from January 2006 to December 2008. All patients had traumatic brain damage proven on computed tomography (CT) or magnetic resonance imaging (MRI). Relevant prehospital and clinical data from the present cohort were compared to data from a similar study ( n = 30) conducted 20 years ago. The primary outcome assessed was mortality. Results: The two study groups had similar characteristics with regard to the GCS score. In the historic cohort, Basic Life Support (BLS) and the 'scoop and run' approach in patients with major traumatic brain injury was common, with an average time on scene of 7.5 min. Currently, prehospital care is performed mainly on the level of prehospital Advanced Life Support (ALS), with the average time on scene being about four times as long as in the historic cohort. However, the overall mortality rate for the current cohort compared to the historic cohort has not changed. Conclusion: Despite more on-site ALS in severely head injured patients nowadays compared to the historic cohort, there was no reduction in mortality. [ABSTRACT FROM AUTHOR]

We assessed dietary exposure of the little owl Athene noctua to trace metal contamination in a Dutch Rhine River floodplain area. Diet composition was calculated per month for three habitat types, based on the population densities of six prey types (earthworms, ground beetles and four small mammal species) combined with the little owl’s functional response to these prey types. Exposure levels showed a strong positive relationship with the dietary fraction of earthworms, but also depended on the dietary fraction of common voles, with higher common vole fractions resulting in decreasing exposure levels. Spatio-temporal changes in the availability of earthworms and common voles in particular resulted in considerable variation in exposure, with peaks in exposure exceeding a tentative toxicity threshold. These findings imply that wildlife exposure assessments based on a predefined, average diet composition may considerably underestimate local or intermittent peaks in exposure. [Copyright &y& Elsevier]

Summary: Implementation of case findings according to guidelines for osteoporosis in fracture patients presenting at a Fracture Liaison Service (FLS) was evaluated. Despite one guideline, all FLSs differed in the performance of patient selection and prevalence of clinical risk factors (CRFs) indicating the need for more concrete and standardised guidelines. Introduction: The aim of the study was to evaluate the implementation of case findings according to guidelines for osteoporosis in fracture patients presenting at FLSs in the Netherlands. Methods: Five FLSs were contacted to participate in this prospective study. Patients older than 50 years with a recent clinical fracture who were able and were willing to participate in fracture risk evaluation were included. Performance was evaluated by criteria for patient recruitment, patient characteristics, nurse time, evaluated clinical risk factors (CRFs), bone mineral density (BMD) and laboratory testing and results of CRFs and BMD are presented. Differences between FLSs were analysed for performance (by chi-square and Student's t test) and for prevalence of CRFs (by relative risks (RR)). Results: All FLSs had a dedicated nurse spending 0.9 to 1.7 h per patient. During 39 to 58 months follow-up, 7,199 patients were evaluated (15 to 47 patients/centre/month; mean age, 67 years; 77% women). Major differences were found between FLSs in the performance of patient recruitment, evaluation of CRFs, BMD and laboratory testing, varying between 0% and 100%. The prevalence of CRFs and osteoporosis varied significantly between FLSs (RR between 1.7 and 37.0, depending on the risk factor). Conclusion: All five participating FLSs with a dedicated fracture nurse differed in the performance of patient selection, CRFs and in the prevalence of CRFs, indicating the need for more concrete and standardised guidelines to organise evaluation of patients at the time of fracture in daily practice. [ABSTRACT FROM AUTHOR]

The Wood mouse (Apodemus sylvaticus) is a widespread mammalian species that acts as a reservoir host for multiple infections, including zoonotic diseases. Exposure to immunotoxins, like for instance trace metals, may reduce the ability of the host to mount proper responses to pathogens, potentially increasing the transmission and prevalence of infections. Antibody-mediated responses are crucial in preventing and limiting infections, and the quantification of the primary antibody response is considered a sensitive predictor of immunosuppression. The current study aims to investigate effects of cadmium exposure on the antibody-mediated responses of wood mice inhabiting polluted and non-polluted areas in the Netherlands. Wood mice were captured alive at different locations and immunized to sheep red blood cells (SRBC) to induce a primary antibody response. SRBC-specific antibody-producing cells, or plaque forming cells (PFC), were quantified and related to kidney cadmium levels. Differential circulating main leukocyte populations were also characterised. Cadmium concentrations in mice kidneys differed between mice captured at different locations, and increased with individual body mass, likely associated with age-related time of exposure. Effect of cadmium was apparent on the percentages of B cell counts in blood. Because of potential natural immune heterogeneity between wild rodent populations, mice immune responses were analysed and compared grouped by captured locations. Capture location had significant effect on the total counts of white blood cells. Increasing cadmium exposure in wood mice captured from polluted sites was associated with a decrease of splenic PFC counts. This field research shows that wood mice antibody responses can be impaired by cadmium exposure, even at low environmental levels, by affecting B cell functioning mainly. Impaired B cell function can make exposed mice more susceptible to infections, potentially increasing the reservoir function of their populations. It also shows that immunomodulatory effects in the field should be assessed site specifically. [Display omitted] • Cadmium exposure did not significantly affect white blood cell counts or -populations in wood mice. • Environmental exposure decreased functioning of Plaque Forming Cells. • Immunomodulatory effect of cadmium mice were similar in extent among sites. • Chemical effects on the immune system of wildlife should be studied within site. [ABSTRACT FROM AUTHOR]

This article presents the findings of an in-depth comparative study of remand decision-making in youth courts in England & Wales and the Netherlands. Informed by qualitative empirical research, this article explores differences and similarities in remand decision-making and in the functions of remand in the administration of youth justice. A key finding is that in Dutch youth justice a paternalistic and interventionist perception of the 'welfare principle' seems to be an important informal driver of the (relatively) high youth remand rates, whereas in the English youth justice system the 'welfare principle' seems to function rather as a protective mechanism against an overzealous use of youth remand. Ultimately, the article explores how different legal traditions and 'proximal processes' might explain and shape cross-national differences in the use of remand for youth and identifies several areas for further inquiry that can potentially advance our broader international comparative understanding of youth remand practices. [ABSTRACT FROM AUTHOR]