Search

Background Steatotic liver disease is suggested to have a higher prevalence and severity in people with HIV (PHIV), including in those with a normal body mass index (BMI). In this study, we used data from the 2000HIV cohort to (1) assess the prevalence of liver steatosis and fibrosis in lean versus overweight/obese PHIV and (2) assess associations in these subgroups between steatosis and fibrosis with traditional risk factors and HIV-specific characteristics. Methods The 2000HIV study cohort comprises 1895 virally suppressed PHIV that were included between 2019 and 2021 in 4 HIV treatment centers in the Netherlands. The majority (58.5%) underwent vibration-controlled transient elastography for the assessment of liver steatosis and fibrosis. The prevalence of steatosis (controlled attenuation parameter ≥263 dB/m) and fibrosis (liver stiffness measurement ≥7.0 kPa) was estimated. Multiple factors including HIV characteristics and antiretroviral drugs were tested in a logistic regression model for association with steatosis and fibrosis. Analyses were performed separately for lean (Asian descent: BMI < 23 kg/m2, other descent: BMI < 25 kg/m2) and overweight/obese (other BMI) participants. Results Of 1050 PHIV including 505 lean and 545 overweight/obese PHIV, liver steatosis was observed in 37.7% of the overall study population, 19.7% of lean, and 54% of overweight/obese PHIV, whereas fibrosis was observed in 9.0% of the overall study population, 5.9% of lean, and 12.0% of overweight/obese PHIV. All associations with fibrosis and most associations with steatosis concerned metabolic factors such as type 2 diabetes mellitus (overall population: adjusted odds ratio [aOR] for steatosis: 2.3 [1.21-4.4], P =.011; aOR for fibrosis: 3.7 [1.82-7.53], P <.001). Furthermore, in lean PLHIV, liver steatosis was associated with CD4 and CD8 counts at enrollment, dual therapy, and history of treatment with raltegravir (aOR: 3.6 [1.53-8.47], P =.003), stavudine (aOR: 3.73 [1.69-8.2], P =.001), and indinavir (aOR: 3.86 [1.59-9.37], P =.003). These associations were not observed in overweight/obese PHIV. Conclusions Liver steatosis was highly prevalent, affecting approximately one-fifth of lean PHIV and half of overweight/obese PHIV. Fibrosis was observed in a minority. Both steatosis and fibrosis were associated with traditional metabolic risk factors. In addition, (prior) exposure to specific antiretroviral drugs was associated liver steatosis in lean, but not in overweight/obese PHIV. Implementing increased screening protocols could enhance the identification of steatotic liver disease in lean PHIV. [ABSTRACT FROM AUTHOR]

The European Habitats Directive prescribes Member States to report on trends in abundance and distribution of protected species. One of these species is Graphoderus bilineatus (De Geer, 1774), a middle-sized predaceous aquatic beetle, listed in Annex II and IV of the Habitats Directive. In the Netherlands, a monitoring scheme for this species has been set up to assess the national trend as well as the trend in the national Natura2000 sites. In this scheme, a selection of 1 km2 squares is surveyed in cycles of six years using a standardized field method by professional fieldworkers. In each selected square, five locations were sampled per annum (September–October) by two different observers using hand netting. The data of the first two rounds (2011–2016 and 2017–2022) have been analysed using both an occupancy model and a Poisson GLMM. We found evidence of a declining trend in occupancy as well as in population size. The decreases were stronger outside than within Natura2000 sites and also stronger than those of three other beetle species that are often found together with G. bilineatus. In addition, considerable differences between observers were detected in the data, despite the application of a standardized field method. Implications for insect conservation: Graphoderus bilineatus is declining and the decline is stronger outside Natura2000 sites then within, most likely due to differences in the development of water quality, vegetation structure and water management. Further research is required to identify the exact causes of the decline; however water quality improvement seems essential to turn the tide. The study also shows the benefits of a monitoring scheme for trend assessments. The recent decline would probably not have been noticed based on distribution data alone. [ABSTRACT FROM AUTHOR]

Background and Objectives: Donor characteristics have been implicated in transfusion‐related adverse events. Uncertainty remains about whether sex, and specifically pregnancy history of the blood donor, could affect patient outcomes. Whether storage duration of the blood product could be important for patient outcomes has also been investigated, and a small detrimental effect of fresh products remains a possibility. Here, we hypothesize that fresh red blood cell products donated by ever‐pregnant donors are associated with mortality in male patients. Materials and Methods: We used data from a cohort study of adult patients receiving a first transfusion between 2005 and 2015 in the Netherlands. The risk of death after receiving a transfusion from one of five exposure categories (female never‐pregnant stored ≤10 days, female never‐pregnant stored >10 days, female ever‐pregnant stored ≤10 days, female ever‐pregnant stored >10 days and male stored for ≤10 days), compared to receiving a unit donated by a male donor, which was stored for >10 days (reference), was calculated using a Cox proportional hazards model. Results: The study included 42,456 patients who contributed 88,538 person‐years in total, of whom 13,948 died during the follow‐up of the study (33%). Fresh units (stored for ≤10 days) from ever‐pregnant donors were associated with mortality in male patients, but the association was not statistically significant (hazard ratio 1.39, 95% confidence interval 0.97–1.99). Sensitivity analyses did not corroborate this finding. Conclusion: These findings do not consistently support the notion that the observed association between ever‐pregnant donor units and mortality is mediated by blood product storage. [ABSTRACT FROM AUTHOR]

Introduction: Based on European guidelines, transcatheter aortic valve implementation (TAVI) could be the therapy of choice in patients with severe aortic stenosis aged ≥ 75 years. In the Netherlands, there has been a debate between healthcare providers and the National Health Care Institute regarding reimbursement for TAVI, which resulted in an indication document that defines TAVI patients who are eligible for reimbursement. This document has been effective since 1 January 2021. Methods: We extracted data from the Netherlands Heart Registry for patients who underwent biological surgical aortic valve replacement (SAVR) or TAVI in the Netherlands from 2018 through 2021. We compared baseline characteristics and variables from the indication document for the subsequent years and age groups. We also analysed the annual SAVR/TAVI ratio. Results: The total number of patients treated with SAVR or TAVI was constant in 2018–2021. Baseline characteristics of patients treated with TAVI did not differ throughout the years. The SAVR/TAVI ratio shifted towards a higher percentage of TAVI from 2018 to 2019. From 2019 to 2020, the TAVI percentage was constant. Since the implementation of the indication document (in 2021), a change in the SAVR/TAVI ratio was not found either. Conclusion: Since the implementation of the national indication document for AVR in 2021, no major effect was seen for the SAVR versus TAVI landscape in the Netherlands. [ABSTRACT FROM AUTHOR]

The issue addressed in this study is whether propositional integration and world-knowledge inference can be distinguished as separate processes during the comprehension of Dutch "omdat" (because) sentences. "Propositional integration" refers to the process by which the reader establishes the type of relation between two clauses or sentences. "World-knowledge inference" refers to the process of deriving the general causal relation and checking it against the reader's world knowledge. An eye-tracking experiment showed that the presence of the conjunction speeds up the processing of the words immediately following the conjunction, and slows down the processing of the sentence final words in comparison to the absence of the conjunction. A second, subject-paced reading experiment replicated the reading time findings, and the results of a verification task confirmed that the effect at the end of the sentence was due to inferential processing. The findings evidence integrative processing and inferential processing, respectively. (Contains 4 tables and 2 footnotes.)

This study surveyed and compared support systems for poor readers in six member states of the European Union (EU). The goal was to identify features of effective support systems. A large-scale questionnaire survey was conducted among mainstream teachers (n = 4,210) and remedial teachers (n = 2,395). Results indicate that the six support systems differed substantially, with effective support systems showing high performance on all variables measured. More specifically, effective support systems were characterized by (a) high levels of both teacher "and" student support and (b) frequent interactions between teachers and remedial teachers as well as between remedial teachers and diagnosticians. The high prevalence of poor reading ability in the current EU member states demonstrates that educational reforms are critically needed. The results of this study provide concrete starting points for improving support systems for poor readers. (Contains 9 figures, 4 tables and 2 notes.)

Although the transparency of a writing system is hypothesized to systematically influence the cognitive skills associated with reading development, results of cross-language investigations are inconsistent and usually do not address this issue in a developmental context. We therefore investigated the cognitive dynamics of reading fluency of different word types in Grades 1-4 in three orthographies differing in degree of transparency (Hungarian, Dutch, and Portuguese). The overall results showed that the relative strength of the contributions of phonological awareness and rapid naming to word reading fluency shifted as a function of reading expertise: The contribution of phonological awareness remained significant in all grades but decreased as a function of grade, whereas the contribution of rapid naming increased. Orthographic depth systematically modulated the strength of the cognitive contributions to reading, but not the overall developmental pattern. Together, these results indicate that the cognitive development of reading skill is fairly universal (at least for alphabetic scripts) and that differences in orthographic depth will not recruit different cognitive processes but will mainly be expressed in rate of reading development. (Contains 8 tables and 4 figures.)

This paper reports the results of two studies of reading comprehension of Flemish children in Belgium. In the northern part of Belgium (Flanders), Dutch is the official language. The Dutch-speaking inhabitants of Flanders are called Flemish. Dutch is also the national language of the Netherlands. Despite both groups using Dutch, cultural differences between the groups are reflected in healthcare and education. Study 1 investigated the effect of these differences on the reading comprehension of deaf children. Reading levels of Flemish deaf children with cochlear implants (CI) (n = 30) or hearing aids (HA) (n = 44) were compared with reference data of Dutch deaf children with CI (n = 50) and HA (n = 500), and with a hearing norm group. Study 2 investigated sources of variability by examining the underlying processes of reading comprehension of good and poor Flemish deaf readers from the CI group in Study 1. Results of Study 1 showed significantly better reading levels for the two Flemish groups. These differences may reflect Belgian policy aiming at early implantation and the use of spoken language communication. The second study contrasted good and poor readers' working memory capacity scores, including verbal and non-verbal working memory scores, morphosyntactic ability, and phonological encoding in order to explore which underlying processes contributed to reading performance in the Flemish CI users. Results showed a tendency toward better morphosyntactic abilities and better working memory skills in the good readers. Three factors appear to explain the better reading of Flemish children with CIs: amount of spoken language input in communication, access to spoken language through a cochlear implant, and age at implantation. (Contains 2 tables and 6 figures.)

Superlative quantifiers ("at least 3", "at most 3") and comparative quantifiers ("more than 2", "fewer than 4") are traditionally taken to be interdefinable: the received view is that "at least n" and "at most n" are equivalent to "more than n-1" and "fewer than n+1", respectively. Notwithstanding the prima facie plausibility of this claim, Geurts and Nouwen (2007) argue that superlative quantifiers have essentially richer meanings than comparative ones. Geurts and Nouwen's theory makes three kinds of predictions that can be tested by experimental means. First, it predicts that superlative and comparative quantifiers should give rise to different patterns of reasoning. Second, the theory leads us to expect that children will master comparative quantifiers before superlative ones. Third, superlative quantifiers should be harder to process than comparative ones. We present three experiments that confirm these predictions. (Contains 7 footnotes and 8 tables.)

Some of the most significant changes in information technology are those that have given the individual user greater power to choose. The first of these changes was the development of the personal computer. The PC liberated the individual user from the limitations of the mainframe and minicomputers and from the rules and regulations of centralized system management. Individual users could install PCs on college and university campuses without obtaining the approval of the central IT organization. Subsequent waves of change--the World Wide Web, mobile devices, Web 2.0 functionality, and virtualization--continued to benefit users as interlinked PCs and other personal devices delivered information and innovative new applications to individuals connected via global networks. Today "cloud services"--such as Wikipedia, Hotmail, and YouTube--were available before the phrase "cloud service" was even coined. Colleges and universities around the world are discussing, planning for, and using cloud computing and cloud services. The rate of adoption varies from country to country, but the need for awareness and preparation is universal. This article examines cloud issues by looking at examples from Australia, Canada, the Netherlands, and the United Kingdom which illustrate both the opportunities and the risks involved in adopting cloud computing and cloud services. (Contains 11 notes.)

This article presents a Web 2.0 approach for the arrangement of peer tutoring in online learning. In online learning environments, the learners' expectations of obtaining frequent, one-to-one support from their teachers tend to increase the teachers' workloads to unacceptably high levels. To address this problem of workload a self-organised peer allocation mechanism is proposed for the easy arrangement of instant tutoring by fellow students. The approach is based on a computational model which selects the most appropriate peer from a population of learners. A software prototype has been developed and tested with learners in two different educational settings. The evaluation shows that the use of a self-organising, synchronous peer-allocation system is not self-evident. It may be successful, but context variables have great impact on its functioning. Although the system technically functioned appropriately, students often appeared to use alternative ways for asking for help. In view of its potential for the efficient arrangement of distributed online support recommendations are given for successful appliance of the approach. (Contains 2 figures.)

This international comparative study addresses differences between adolescents who engage in deliberate self-harm (DSH) and who receive help following the DSH episode versus those who do not. A standardized self-report questionnaire was completed by pupils aged 14-17 in Australia, Belgium, England, Hungary, Ireland, The Netherlands, and Norway (n = 30 532). An act of DSH in the year prior to the study was reported by 1660 participants. Nearly half (48.4%) had not received any help following DSH, 32.8% had received help from their social network only and 18.8% from health services. Except for Hungary, cross-national comparisons revealed remarkably similar findings. Adolescents who had been in contact with health services following DSH reported more often a wish to die, lethal methods, alcohol/drug problems and DSH in the family compared to those who had not. However, those who received no help or help from their social network only were also heavily burdened. (Contains 1 figure and 3 tables.)

Several studies showed how coherence markers, like connectives and lexical cue phrases, influence the processing and representation of informative text. Although discourse analysts have repeatedly argued that coherence markers influence the processing of persuasive text as well, there is hardly any empirical evidence for this idea. This article reports on 2 experiments investigating the possible forewarning effect of coherence marking: When coherence markers cause readers to recognize an attempt to influence them, they build up resistance and it becomes difficult to persuade them. The experiments show that objective marking is more persuasive than subjective marking. Also, subjective marking causes readers to recognize the persuasive author's intent more easily. Furthermore, subjective markers seem to cause resistance to persuasion, whereas objective markers improve integration of information. (Contains 3 boxes, 5 tables, and 2 figures.)

Coherence plays a central role when readers construct meaning from a text. Previous research has shown how coherence marking affects text processing and representation. However, this effect seems to depend on reader's prior knowledge of the text content: Low knowledge readers benefit from coherence marking, whereas high knowledge readers benefit from a more implicit text (McNamara & Kintsch, 1996). Because this interaction was not consistently found in previous research, this article takes a closer look at the operationalization of the experimental variables: coherence marking, prior knowledge, and text comprehension. Also, this article compares the effect on both informative and persuasive texts. Results indicate that linguistic marking of coherence indeed interacts with prior knowledge in the informative genre, but not in the persuasive genre. (Contains 2 tables, 2 figures and 3 footnotes.)

Background: Deliberate self-harm among young people is an important focus of policy and practice internationally. Nonetheless, there is little reliable comparative international information on its extent or characteristics. We have conducted a seven-country comparative community study of deliberate self-harm among young people. Method: Over 30,000 mainly 15- and 16-year-olds completed anonymous questionnaires at school in Australia, Belgium, England, Hungary, Ireland, the Netherlands and Norway. Study criteria were developed to identify episodes of self-harm; the prevalence of self-harm acts and thoughts, methods used, repetition, reasons given, premeditation, setting for the act, associations with alcohol and drugs, hospitalisation, and whether other people knew, were examined. Results: Self-harm was more than twice as common among females as males and, in four of the seven countries, at least one in ten females had harmed herself in the previous year. Additional young people had thought of harming themselves without doing so. More males and females in all countries except Hungary cut themselves than used any other method, most acts took place at home, and alcohol and illegal drugs were not usually involved. The most common reasons given were "to get relief from a terrible state of mind" followed by "to die", although there were differences between those cutting themselves and those taking overdoses. About half the young people decided to harm themselves in the hour before doing so, and many did not attend hospital or tell anyone else. Just over half those who had harmed themselves during the previous year reported more than one episode over their lifetime. Conclusions: Deliberate self-harm is a widespread yet often hidden problem in adolescents, especially females, which shows both similarities and differences internationally.

A comparison between the Netherlands and Germany concerning religious, cultural and ethnic plurality provides interesting insights. Germany has never defined itself as a multicultural society, as was historically the case in the Netherlands. The outcomes of the research are somewhat surprising. Dutch pupils--especially boys--are more negative about plurality than their German contemporaries are. Belonging to a church in Germany appears to be connected to a positive attitude to migrants, while in the Netherlands this is not important at all. (Contains 7 tables and 1 note.)

This study assesses the prevalence of combined reading and arithmetic disabilities in 799 Dutch schoolchildren using standardized school achievement tests. Scores of arithmetic, word recognition, reading comprehension, and spelling of children in fourth and fifth grade were used. The main interest involved the co-occurrence of word recognition and arithmetic disabilities because of their possible relationship. The authors find a percentage of 7.6 for combined reading and arithmetic disabilities. Reading disabilities and arithmetic disabilities co-occurred more often than expected based on rates of the separate conditions. Children with combined reading and arithmetic disabilities seem to have more generalized achievement difficulties than single-deficit groups. Different operationalizations for reading disabilities (spelling and reading comprehension measures instead of word recognition) led, in part, to selection of other children. This might imply that different processes underlie the relationship between arithmetic and word recognition disabilities compared to the relationship of arithmetic disabilities with difficulties in spelling and reading comprehension. (Contains 5 tables.)

The combination of mathematical and conceptual difficulties makes teaching quantum physics at secondary schools a precarious undertaking. With many of the conceptual difficulties being unavoidable, simplifying the mathematics becomes top priority. The particle/wave-in-a-box provides a teaching model which includes many aspects of serious quantum physics, while avoiding most of the mathematics. In a Dutch quantum physics project for secondary schools, this model was adopted to play a key role. Much to our surprise, we ran into many more applications than we originally expected. In many instances the model yields order of magnitude estimates, for instance of atomic and nuclear size, or qualitative insights, for instance about energy levels, molecular bonding and electron pressure. Moreover, either directly or with minor modifications, the particle-in-a-box model provides reasonable approximations of a range of phenomena, including the absorption spectra of organic pigments, the mass of the proton and the spectra of quantum dots.

As one of the first countries in Europe to do so, The Netherlands moved towards a new relationship between the state and the higher education institutions in the mid-1980s. Autonomy, quality and accountability were key considerations in this move. In 2006 the Dutch government proposed another radical innovation in its approach to higher education governance, based on the concepts of duties of care and codes of conduct. In this article the new approach is critically discussed and its potential and drawbacks highlighted. (Contains 4 notes.)

Background: The present study explores the relationships between several information processing capacities and internalizing and externalizing behavior problems in a general population sample of 10- to 12-year olds (N = 2,037 51% girls). Methods: Parent-reported behavior problems as assessed by the Child Behavior Checklist were used to form four groups of children with 1) neither internalizing nor externalizing problems (n = 1,470), 2) only internalizing problems (n = 237), 3) only externalizing problems (n = 182), and 4) both internalizing and externalizing problems (n = 148). These groups were compared on measures of speed and accuracy from the Amsterdam Neuropsychological Tasks program reflecting the efficiency of several input-, central cognitive-, and output-related information processing capacities. Results: Children with both internalizing and externalizing problems demonstrated the least efficient performance, followed by children with only externalizing problems, whereas children with only internalizing problems did not differ from children without problems. More specifically, response variability and the ability to maintain and quickly compare information in working memory were found to be related to the severity of problem behavior. The ability to inhibit prepotent responses was related to the type of problem behavior, discriminating between the children with only internalizing problems and only externalizing problems. However, this latter capacity no longer differentiated when controlling for IQ. No differences were found between boys and girls. Conclusions: The results suggest that, in general, cognitive processing deficits are more strongly related to the degree than to the type of maladaptive behavior. Furthermore, response variability and working memory may serve as potential markers for identifying high-risk children and response inhibition as an indicator of the type of maladaptive behavior.

In 1997 a new governance act, based on the principles of New Public Management (NPM) was introduced at Dutch universities. The aims were to realise integrated management, to strengthen the position of executives at the central (executive board) and faculty (dean) levels, to introduce a Supervisory Board at the institution's central level, and to increase the leeway for universities to design its own governance structure. This article reports on a large-scale evaluation of the governance act and focuses on student and staff participation in decision-making and on the actual appraisal of different actors within the universities (leaders, managers, staff, students) of the governance structure of their university. The empirical data reveal a mixed picture regarding the appreciation of the new governance structure, but overall--in contrast with many critical reviews of NPM in higher education--there seems to be considerable endorsement for the present situation.

Purpose--To present the challenge of sustainable development, the way in which technology can address that challenge and the task of engineering education to train engineers for it. Design/methodology/approach--The paper describes briefly the history of the environmental and sustainability discourse in The Netherlands, as a densely populated country. It argues that technology should play a major role in SD, but that technological innovation is not enough. Technological systems renewal is a transdisciplinary activity involving relevant stakeholders and disciplines. "Needs" is the basic starting-point to innovate new systems of provision. The paper reviews relevant literature regarding future orientation of technology development. Based on it, goals for training of engineers are developed. Findings--The engineer has to meet a threefold challenge: providing new creative approaches on the one hand, and setting up and executing R&D programs that produce results, on the other; cooperating with other disciplines and lay stakeholders, on the one hand, and guarding disciplinary quality, on the other; bridging moralism and strategic pragmatism. Research limitations/implications--The paper is an introduction, i.e. it sketches the issues without dealing with them in detail. Practical implications--The paper draws in broad lines a road-map for the future of engineering education and sustainable development. The paper is a useful source for those engineering institutions that are formulating a strategy to introduce sustainable development. Originality/value--The paper goes beyond environmental engineering, not by just adding social and economic issues, but by developing an integrated framework for academic training of engineers. (Contains 1 figure and 3 notes.)

High-tech greenhouses are characterised by high yields and high energy consumption. Current trends towards expanded use of supplemental lighting further increase the intensity of crop production and energy use, and it is expected that the availability of light-emitting diodes (LEDs) will accelerate this trend. At the same time, an increase in greenhouse lighting reduces the heating energy needed from the heating system. This study presents a novel concept for greenhouses, where both lighting and heating are derived exclusively from lamps. Such greenhouses can be highly efficient, as light is used both for crop growth and for heating. If the electric grid is based on renewable sources, such greenhouses can also be carbon-neutral and fossil-free. By using model simulations for a tomato greenhouse in the Netherlands, it was found that such greenhouses could be realised by employing a heat storage system with a heat storage capacity of 2 MJ m−2 and LEDs with a power capacity of 150 W m−2 and a photosynthetic photon flux density (PPFD) of 450 μmol m−2 s−1. The greenhouse heated by light was predicted to have 44% higher yields and 60% higher energy inputs than a reference greenhouse, equipped with a boiler and LEDs with a PPFD of 200 μmol m−2 s−1. This result was part of a general trade-off that was found between yield and energy efficiency. This exploration helped identify avenues for further improvement of the energy efficiency of greenhouses heated by lamps, highlighting their promise as a potential new direction in greenhouse intensification. • A novel approach for greenhouse climate control, using only lamps and no boiler. • Model simulations uncover the attributes required to make such systems feasible. • Increasing lamp intensity alone increases yields but reduces energy efficiency. • Avenues for improving the energy efficiency of heating by light are proposed. [ABSTRACT FROM AUTHOR]

Analyzes the recent evolution in higher education linkages between northern and southern countries from individual academic projects toward broader development cooperation. Reviews different linkage programs in Canada, the Netherlands, Norway, and Sweden. Focuses on key issues concerning organization, procedures, and support mechanisms, and raises questions about the mandate and capabilities of the donor institutions. Contains 24 references. (VWC)

Studies students' perceptions of the moral atmosphere in various levels of secondary schools in the Netherlands. Reveals significant differences between schools and school types based on analysis of variance. Does not claim any ability to predict undesirable behaviors at school based on measures of moral atmosphere. Includes the survey form. (DSK)

Objectives MRSA carrying the mecC gene (mecC -MRSA) have been found in humans and animals worldwide. A high carriage rate of mecC -MRSA has been described among hedgehogs in different countries. We performed genomic comparison of mecC -MRSA from hedgehogs and humans using next-generation sequencing (NGS) to investigate possible zoonotic transmission in the Netherlands. Methods Nasal swabs from hedgehogs (n  = 105) were cultured using pre-enrichment and selective plates. Isolates were sequenced using Illumina NGS platforms. These data were compared with sequence data of mecC -MRSA (n  = 62) from the Dutch national MRSA surveillance in humans. Results Fifty hedgehogs were found to be MRSA positive, of which 48 carried mecC. A total of 60 mecC -MRSA isolates derived from 50 hedgehogs were compared with the human isolates. Fifty-nine mecC -MRSA from hedgehogs and all but one isolate from humans belonged to clonal complexes CC130 and CC1943. The mecC gene was located within the SCC mec XI element. Most mecC -MRSA did not carry other resistance genes besides mecC and blaZ. Two human isolates carried erm (C). Isolates differed in the presence of various virulence genes, which were linked to distinct STs and clonal complexes. Some isolates had up to 17 virulence genes, which underlines their pathogenic potential. No genetic clusters of hedgehog and human isolates were found. Conclusions mecC- MRSA from hedgehogs and humans mainly belonged to the same two clonal complexes, indicating a common source. No firm evidence for recent zoonotic transmission was found. Further studies are needed to investigate the role of hedgehogs in the occurrence of mecC -MRSA in humans. [ABSTRACT FROM AUTHOR]

There is little known about the dynamics within responses to Borrelia spp. upon repeated exposure to tick bites and the development of serological markers over time. Most studies have investigated antibody development in risk populations over a short period of time. Therefore, we aimed to study the dynamics of anti-Borrelia antibodies in forestry service workers over 8 years in association with tick bite exposure. Methods: Blood samples from 106 forestry service workers originally included in the 200 Functional Genomics Project (Radboudumc, Nijmegen, the Netherlands) were followed for 8 years and tested annually for anti-Borrelia antibodies (ELISA and Western blot). IgG seroconversion was related to the number of tick bites in the previous year, which was obtained through annual questionnaires. The hazard ratio for Borrelia IgG seroconversion was calculated using Cox regression survival analysis and a logistic regression model, both adjusting for age, gender and smoking. Results: Borrelia IgG seropositivity in the study population did not vary significantly between years and the average prevalence was 13.4%. Of the 27 subjects that underwent seroconversion during the study period, 22 reconverted from positive to negative. Eleven subjects seroconverted a second time. The total seroconversion rate per year (negative to positive) was 4.5%. Active smoking was associated with IgG seroconversion in the >5 tick bites group (p < 0.05). According to the two models used, the risks of IgG seroconversion in the >5 tick bites group were HR = 2.93 (p = 0.10) and OR = 3.36 (p < 0.0005). Conclusions: Borrelia IgG seroconversion in forestry service workers was significantly related to increasing tick bite exposure in a survival and logistic regression model adjusting for age, gender and smoking. [ABSTRACT FROM AUTHOR]

Background Multiple organ dysfunction syndrome (MODS) is associated with a high risk of mortality among older patients. Current severity scores are limited in their ability to assist clinicians with triage and management decisions. We aim to develop mortality prediction models for older patients with MODS admitted to the ICU. Methods The study analyzed older patients from 197 hospitals in the United States and 1 hospital in the Netherlands. The cohort was divided into the young-old (65–80 years) and old-old (≥80 years), which were separately used to develop and evaluate models including internal, external, and temporal validation. Demographic characteristics, comorbidities, vital signs, laboratory measurements, and treatments were used as predictors. We used the XGBoost algorithm to train models, and the SHapley Additive exPlanations (SHAP) method to interpret predictions. Results Thirty-four thousand four hundred and ninety-seven young-old (11.3% mortality) and 21 330 old-old (15.7% mortality) patients were analyzed. Discrimination AUROC of internal validation models in 9 046 U.S. patients was as follows: 0.87 and 0.82, respectively; discrimination of external validation models in 1 905 EUR patients was as follows: 0.86 and 0.85, respectively; and discrimination of temporal validation models in 8 690 U.S. patients: 0.85 and 0.78, respectively. These models outperformed standard clinical scores like Sequential Organ Failure Assessment and Acute Physiology Score III. The Glasgow Coma Scale, Charlson Comorbidity Index, and Code Status emerged as top predictors of mortality. Conclusions Our models integrate data spanning physiologic and geriatric-relevant variables that outperform existing scores used in older adults with MODS, which represents a proof of concept of how machine learning can streamline data analysis for busy ICU clinicians to potentially optimize prognostication and decision making. [ABSTRACT FROM AUTHOR]

BACKGROUND: Lung ultrasound (LUS) can be used to monitor critically ill patients with COVID-19, but the optimal number of examined lung zones is disputed. METHODS: This was a prospective observational study. The objective was to investigate whether concise (6 zones) and extended (12 zones) LUS scoring protocols are clinically equivalent in critically ill ICU subjects with COVID-19. The primary outcome of this study was (statistical) agreement between concise and extended LUS score index evaluated in both supine and prone position. Agreement was determined using correlation coefficients and Bland-Altman plots to detect systematic differences between protocols. Secondary outcomes were difference between LUS score index in supine and prone position using similar methods. RESULTS: We included 130 LUS examinations in 40 subjects (mean age 69.0 ± 8.5y, 75% male). Agreement between concise and extended LUS score index had no clinically relevant constant or proportional bias and limits of agreement were below the smallest detectable change. Across position changes, supine LUS score index was 8% higher than prone LUS score index and had limits above the smallest detectable change, indicating true LUS score index differences between protocols may occur due to the position change itself. Lastly, inter-rater and intra-rater agreement were very good. CONCLUSIONS: Concise LUS was equally informative as extended LUS for monitoring critically ill subjects with COVID-19 in supine or prone position. Clinicians can monitor patients undergoing position changes but must be wary that LUS score index alterations may result from the position change itself rather than disease progression or clinical improvement. [ABSTRACT FROM AUTHOR]

The Dutch binary system of higher education and trends toward increased vocationalism are discussed. The article notes the governmental policy to encourage the technical and natural sciences and explores new relationships between the university and higher vocational education sectors. A policy of parity in resources with clear distinction of the two sectors' roles is recommended. (DB)

A discussion of recent changes in Dutch higher education provides an overview of the educational system and recent retrenchment and restructuring efforts, and formulates a framework for policy analysis that treats the system as a policy network. Basic processes influencing the outcomes of government policies promoting change are examined. (Author/MSE)

Higher education in Australia and the Netherlands illustrates two international trends: restructuring toward systems of fewer, larger institutions; and government tendencies to continue setting broad policies while decentralizing other responsibilities to institutions. Success in restructuring is attributed to the interaction of public policy and changing political and ideological environments. (SV)

Discusses the importance of experience and experiential learning in distance education. Models of prior knowledge and experiential learning are discussed, the measurement of experiential learning is described, a model of the portfolio assessment method is explained, and implications for Dutch higher education and the Open University are suggested. (21 references) (LRW)

Plant-to-plant variation (interplant variation) may play an important role in determining individual plant and whole canopy performance, where interplant variation in architecture and photosynthesis traits has direct effects on light absorption and photosynthesis. We aimed to quantify the importance of observed interplant variation on both whole-plant and canopy light absorption and photosynthesis. Plant architecture was measured in two experiments with fruiting tomato crops (Solanum lycopersicum) grown in glasshouses in the Netherlands, in week 16 (Exp. 1) or week 19 (Exp. 2) after transplanting. Experiment 1 included four cultivars grown under three supplementary lighting treatments, and Experiment 2 included two different row orientations. Measured interplant variations of the architectural traits, namely, internode length, leaf area, petiole angle, and leaflet angle, as well as literature data on the interplant variation of the photosynthesis traits alpha, Jmax28, and Vcmax28, were incorporated in a static functional--structural plant model (FSPM). The FSPM was used to analyze light absorption and net photosynthesis of whole plants in response to interplant variation in architectural and photosynthesis traits. Depending on the trait, introducing interplant variation in architecture and photosynthesis traits in a functional--structural plant model did not affect or negatively affected canopy light absorption and net photosynthesis compared with the reference model without interplant variation. Introducing interplant variation of architectural and photosynthesis traits in FSPM results in a more realistic simulation of variation of plants within a canopy. Furthermore, it can improve the accuracy of simulation of canopy light interception and photosynthesis although these effects at the canopy level are relatively small (<4% for light absorption and<7% for net photosynthesis). [ABSTRACT FROM AUTHOR]

BACKGROUND: Given the long ventilation times of patients with COVID-19 that can cause atrophy and contractile weakness of respiratory muscle fibers, assessment of changes at the bedside would be interesting. As such, the aim of this study was to determine the evolution of respiratory muscle thickness assessed by ultrasound. METHODS: Adult (> 18 y old) patients admitted to the ICU who tested positive for SARS-CoV-2 and were ventilated for < 24 h were consecutively included. The first ultrasound examination (diaphragm, rectus abdominis, and lateral abdominal wall muscles) was performed within 24 h of intubation and regarded as baseline measurement. After that, each following day an additional examination was performed, for a maximum of 8 examinations per subject. RESULTS: In total, 30 subjects were included, of which 11 showed ≥ 10% decrease in diaphragm thickness from baseline; 10 showed < 10% change, and 9 showed ≥ 10% increase from baseline. Symptom duration before intubation was highest in the decrease group (12 [11-14] d, P = .03). Total time ventilated within the first week was lowest in the increase group (156 [129-172] h, P = .03). Average initial diaphragm thickness was 1.4 (1.1-1.6) mm and did not differ from final average thickness (1.3 [1.1-1.5] mm, P = .54). The rectus abdominis did not show statistically significant changes, whereas lateral abdominal wall thickness decreased from 14 [10-16] mm at baseline to 11 [9-13] mm on the last day of mechanical ventilation (P = .08). Mixed-effect linear regression demonstrated an association of atrophy and neuromuscular-blocking agent (NMBA) use (P = .01). CONCLUSIONS: In ventilated subjects with COVID-19, overall no change in diaphragm thickness was observed. Subjects with decreased or unchanged thickness had a longer ventilation time than those with increased thickness. NMBA use was associated with decreased thickness. Rectus muscle thickness did not change over time, whereas lateral abdominal muscle thickness decreased but this change was not statistically significant. [ABSTRACT FROM AUTHOR]

1. Revealing the ecological consequences of bark multifunctionality and its underlying traits has become a relatively new but essential focus in plant ecology. Although the enormous differences between the most crucial bark layers, that is, inner and outer bark, in structure and functions have been widely recognized, the overall bark has been regarded as a homogenous tissue in most bark-related studies. This has led to poor knowledge on the functional independence, specialized contributions and possible linkages of inner and outer bark traits across tree species when further evaluating the crucial ecosystem functions that bark provides, especially in driving variation in bark decomposition. 2. To fill this research gap, we used a ‘common garden experiment’ on deadwood of six gymnosperms in a temperate forest in the Netherlands over 4 years of decomposition. We evaluated the differences and associations between the inner and outer bark in initial functional traits, decomposition rates and afterlife effects of traits in driving in situ bark decomposition across tree species at the earlier decomposition stage. 3. We report four main findings: (1) inner and outer bark traits varied significantly and were not coordinated across tree species; (2) correspondingly, the decomposition of the inner and outer bark were asynchronous and not coordinated across species and inner bark generally decomposed faster than outer bark; (3) the strong predictive traits driving bark decomposability were bark layer-specific, with several inner bark traits controlling inner bark decomposition rates but outer bark decomposability being poorly predicted by outer bark traits and (4) besides being controlled by inner bark traits, inner bark decomposition was also indirectly regulated by several functional traits and the structure-related trait spectrum of outer bark. 4. Synthesis. This is the first study that has linked functional traits, decomposability and afterlife effects of the inner and outer bark within the bark quantitatively. We highlight the significance of separating functional traits and ecological consequences of the inner and outer bark in research in bark ecology and deadwood dynamics, rather than erroneously considering bark as a homogeneous tissue. Such research will help to better evaluate the function-oriented contribution of bark to the turnover of forest carbon and biogeochemical cycles from local to global scale. [ABSTRACT FROM AUTHOR]

Background: The Netherlands Armed Forces have been successfully using deep-frozen (- 80 °C) thrombocyte concentrate (DTC) for the treatment of (massive) bleeding trauma patients in austere environments since 2001. However, high-quality evidence for the effectiveness and safety of DTCs is currently lacking. Therefore, the MAssive transfusion of Frozen bloOD (MAFOD) trial is designed to compare the haemostatic effect of DTCs versus room temperature-stored platelets (RSP) in the treatment of surgical bleeding.Methods: The MAFOD trial is a single-blinded, randomized controlled non-inferiority trial and will be conducted in three level 1 trauma centres in The Netherlands. Patients 12 years or older, alive at hospital presentation, requiring a massive transfusion including platelets and with signed (deferred) consent will be included. The primary outcome is the percentage of patients that have achieved haemostasis within 6 h and show signs of life. Haemostasis is defined as the time in minutes from arrival to the time of the last blood component transfusion (plasma/platelets or red blood cells), followed by a 2-h transfusion-free period. This is the first randomized controlled study investigating DTCs in trauma and vascular surgical bleeding.Discussion: The hypothesis is that the percentage of patients that will achieve haemostasis in the DTC group is at least equal to the RSP group (85%). With a power of 80%, a significance level of 5% and a non-inferiority limit of 15%, a total of 71 patients in each arm are required, thus resulting in a total of 158 patients, including a 10% refusal rate. The data collected during the study could help improve the use of platelets during resuscitation management. If proven non-inferior in civilian settings, frozen platelets may be used in the future to optimize logistics and improve platelet availability in rural or remote areas for the treatment of (massive) bleeding trauma patients in civilian settings.Trial Registration: ClinicalTrials.gov NCT05502809. Registered on 16 August 2022. [ABSTRACT FROM AUTHOR]

Summary: Dead wood quantity and quality is important for forest biodiversity, by determining wood‐inhabiting fungal assemblages. We therefore evaluated how fungal communities were regulated by stem traits and compartments (i.e. bark, outer‐ and inner wood) of 14 common temperate tree species. Fresh logs were incubated in a common garden experiment in a forest site in the Netherlands. After 1 and 4 years of decay, the fungal composition of different compartments was assessed using Internal Transcribed Spacer amplicon sequencing. We found that fungal alpha diversity differed significantly across tree species and stem compartments, with bark showing significantly higher fungal diversity than wood. Gymnosperms and Angiosperms hold different fungal communities, and distinct fungi were found between inner wood and other compartments. Stem traits showed significant afterlife effects on fungal communities; traits associated with accessibility (e.g. conduit diameter), stem chemistry (e.g. C, N, lignin) and physical defence (e.g. density) were important factors shaping fungal community structure in decaying stems. Overall, stem traits vary substantially across stem compartments and tree species, thus regulating fungal communities and the long‐term carbon dynamics of dead trees. [ABSTRACT FROM AUTHOR]

Objectives: To assess whether (i) high-intensity resistance training (RT) leads to increased muscle strength compared to low-intensity RT in patients with knee osteoarthritis (OA); and (ii) RT with vitamin D supplementation leads to increased muscle strength compared to placebo in a subgroup with vitamin D deficiency. Design: Randomized controlled trial Setting: Outpatient rehabilitation centre Subjects: Patients with knee OA Interventions: 12 weeks of RT at high-intensity RT (70–80% of 1-repetition maximum (1-RM)) or low-intensity RT (40–50% of 1-RM) and 24 weeks of vitamin D (1200 International units vitamin D3 per day) or placebo supplementation. Main measures: Primary outcome measure was isokinetic muscle strength. Other outcome measure for muscle strength was the estimated 1-RM. Secondary outcome measures were knee pain and physical functioning. Results: 177 participants with a mean age of 67.6 ± 5.8 years were included, of whom 50 had vitamin D deficiency. Isokinetic muscle strength (in Newton metre per kilogram bodyweight) at start, end and 24 weeks after the RT was 0.98 ± 0.40, 1.11 ± 0.40, 1.09 ± 0.42 in the high-intensity group and 1.02 ± 0.41, 1.15 ± 0.42, 1.12 ± 0.40 in the low-intensity group, respectively. No differences were found between the groups, except for the estimated 1-RM in favour of the high-intensity group. In the subgroup with vitamin D deficiency, no difference on isokinetic muscle strength was found between the vitamin D and placebo group. Conclusions: High-intensity RT did not result in greater improvements in isokinetic muscle strength, pain and physical functioning compared to low-intensity RT in knee OA, but was well tolerated. Therefore these results suggest that either intensity of resistance training could be utilised in exercise programmes for patients with knee osteoarthritis. No synergistic effect of vitamin D supplementation and RT was found, but this finding was based on underpowered data. [ABSTRACT FROM AUTHOR]

How often are politicians confronted with public allegations of integrity violations? Which types of violations, government levels, and parties do these scandals involve? The Political Integrity Index developed in The Netherlands offers information about the number and types of political integrity scandals in the country since 2013. This article presents a brief overview of the relevant literature on integrity and corruption and on political scandals, with a summary of the conceptual framework and methodology used in our research, as well as some of the results. In the years 2013-2019, 355 political integrity scandals were documented, primarily at the local level of government (79%), involving almost all political parties but with the liberal-conservative People's Party for Freedom and Democracy (Volkspartij voor Vrijheid en Democratie [VVD]) most prominent (90 scandals), and containing all types of integrity violations, with as the most prominent type "misconduct in the private sphere" (30%). The topic of integrity scandals involving politicians is relevant but nearly absent in research on public integrity and corruption. This is a challenge and an invitation to researchers in other countries to do comparable research, which might result in a theoretically and practically useful international political integrity index. For that research, the framework of the Political Integrity Index seems useful. [ABSTRACT FROM AUTHOR]

Background: The Netherlands is currently considered a low endemic country for carbapenem-resistant Enterobacterales (CRE) and carbapenemase-producing Enterobacterales (CPE), experiencing only sporadic hospital outbreaks. This study aims to describe susceptibility to carbapenems and the epidemiology of carbapenemase production in Enterobacterales in the Netherlands in 2017–2019. Methods: Three complementary nationwide surveillance systems are in place to monitor carbapenem susceptibility in the Netherlands. Routine antimicrobial susceptibility test results from medical microbiology laboratories were used to study phenotypic susceptibility of Escherichia coli and Klebsiella pneumoniae. Pathogen surveillance (of all Enterobacterales species) and mandatory notifications were used to describe the characteristics of CPE positive isolates and affected persons. Results: The prevalence of isolates with gradient strip test-confirmed elevated meropenem (> 0.25 mg/L) or imipenem (> 1 mg/L) minimum inhibitory concentration (MIC) in the Netherlands was very low in 2017–2019, with percentages of 0.06% in E. coli and 0.49% in K. pneumoniae, and carbapenem resistances of 0.02% and 0.18%, respectively. A total of 895 unique species/carbapenemase-encoding allele combinations of CPE from 764 persons were submitted between 2017 and 2019, with the annual number of submissions increasing slightly each year. Epidemiological data was available for 660 persons. Screening because of presumed colonisation risk was the reason for sampling in 70.0% (462/660) of persons. Hospitalization abroad was the most common risk factor, being identified in 45.9% of persons. Conclusions: Carbapenem resistance of E. coli and K. pneumoniae remains low in the Netherlands. The annual number of CPE isolates slightly increased during the period 2017–2019. Recent hospitalization abroad is the main risk factor for acquisition of CPE. [ABSTRACT FROM AUTHOR]

Predictive process monitoring aims to produce early warnings of unwanted events. We consider the use of the machine learning method extreme gradient boosting as the forecasting model in predictive monitoring. A tuning algorithm is proposed as the signaling method to produce a required false alarm rate. We demonstrate the procedure using a unique data set on mental health in the Netherlands. The goal of this application is to support healthcare workers in identifying the risk of a mental health crisis in people diagnosed with schizophrenia. The procedure we outline offers promising results and a novel approach to predictive monitoring. [ABSTRACT FROM AUTHOR]